Use of Perioperative Multimodal Pain Management in the US Remains Low, Expert Says

The shift in clinical practice from exclusive use of opioids for pain management in the perioperative setting to a combined approach that optimizes modes of delivery as well as the range of drug classes available remains a work in progress, according to anesthesiologist and pain specialist Edward R Mariano, MD, MAS. Mariano, a professor and vice chair in the department of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine in Stanford, CA, developed a quality anesthesiology measure for perioperative use of nonopioids as part of an overall pain management strategy that Medicare has adopted. But even with evidence-based guidance widely available, a component he refers to as the carrot, and the link of quality assessment to payment, the stick, the needle isn't moving as quickly as he would like to see.

In a recent interview with Patient Care,^© Mariano discussed the practice inertia impeding more consistent adoption of multimodal pain management protocols and his thoughts on how to begin moving beyond it.

Edward R Mariano, MD, MAS, is a professor and vice chair in the department of anesthesiology, perioperative and pain medicine at Stanford University School of Medicine in Stanford, CA and chief of anesthesiology and perioperative care service at the Veterans Affairs Palo Alto Health Care System. Mariano pioneered the use of continuous peripheral nerve blocks for individuals having same-day surgery. He has worked on key national health care initiatives in the US including accreditation of regional anesthesiology and acute pain medicine fellowships, pain management guidelines, and hospital-based standards.