Robert Whitfield MD outlines a surgical pain strategy that cuts narcotic use by combining anti-inflammatories, nerve blocks with long-acting anesthetics, and preoperative gabapentin. Patients in his practice almost never ask for additional pain medication after surgery.
How are you controlling it? Yeah, I mean it's an interesting question. And I, every time I, you know, have to do continuing my medical education or do a, a renewal of a license, there's a whole opioid educational, you know, curriculum. And it's interesting because I've operated in 2026, it'll be 30 years that I've been operating. And we've always used short term narcotics as a way to treat, you know, surgical pain. What I do is called an eras. So it's early recovery after surgery and it's a combination of ondosterone for nausea, an anti inflammatory and you can sub in different anti inflammatories, one's used routinely or celecoxib or naproxen and you can choose whatever. The other thing you want to do is control for neuropathic symptoms because neuropathic pains are really difficult problem for patients and if not appropriately addressed. And we try to do everything up front, we don't try to respond to it after it's already happened because that it's more problematic. So we treat all of our patients up front with a dose of gabapentin or pregabalin. And then post op there is narcotic available if needed but intraop. So during the procedure nerve blocks are done with a combo of short acting and long acting local anesthetics. So we use different combinations like anesthesia does specific nerve blocks with ropivacaine and then we do specific nerve blocks with a combination of, of basically regular Marcane and then liposomal. So the, the short answer is I don't do anything as I was taught, I do everything to avoid what you're describing, which is problems with post op. So it's almost universally unheard of for me to have people ask for more pain medicine. And if they do then we have to be alert to like that's somebody with a metabolism. It's very rare that I would have somebody have an addiction type issue. But.
