Daniel Engelman, MD
Medical Director
Heart, Vascular & Critical Care Services
Baystate Medical Center
Associate Professor of Surgery
University of Massachusetts Medical School-Baystate
Springfield, Massachusetts
How will the ACA and other regulations affect strategies for taking care of post-operative pain? What parameters of success will be evaluated?
How will mandated cardiac surgery bundles that go into effect in January, 2018 affect strategies for perioperative management and ERAS of patients undergoing cardiac surgery?
What has been your experience with the CMMI CABG bundle? And how has this affected your approach to ERAS protocols?
How has attention to optimizing multimodal analgesia to achieve ERAS affected patient care of cardiac surgical patients? And why have you chosen “pre-emptive” IV acetaminophen as a foundational approach to ERAS and outcome optimization in the CABG setting?
Are there any studies available utilizing pre-operative multimodal analgesia before cardiac surgery?
Are there any studies available utilizing pre-operative multimodal analgesia before cardiac surgery?
What are some of the pitfalls of instituting IV acetaminophen after cardiac surgery as opposed to starting it pre- or intra-operatively; and what are the problems associated with either (a) oral acetaminophen or (b) failing to administer ...
What dose of IV acetaminophen do you recommend for your CABG patients and have any of the patients who received IV acetaminophen after cardiac surgery required no other IV narcotics?
What actionable insights can we draw upon from the European experience with IV acetaminophen in the setting of multimodal pain management for surgical procedures?
How has the ERAS movement affected multimodal pain management protocols for CABG? And where does IV acetaminophen fit into these perioperative critical pathways?
What is the optimal dosing for IV acetaminophen and how should it be combined with other modalities? What is the safety profile of IV acetaminophen and what is its opioid-sparing profile for cardiac surgical patients?
Why is IV acetaminophen your foundational multimodal agent? And, as a surgical patient transitions from IV to PO acetaminophen after cardiac surgery, what are some of the pitfalls and tips for making this transition?
What cardiac surgery patients — the elderly and others — are the ideal candidates for IV acetaminophen therapy? What clinical factors suggest this approach is especially appropriate as part of multimodal analgesia?
Can such nonsteroidal agents as IV Toradol be safely used after cardiac surgery? What are the problematic aspects of this approach? And why might IV acetaminophen be preferable in certain patient populations?
Based on your experience, how many doses of IV acetaminophen are required to optimize pain control after cardiac surgery? Do you individualize your approach and, if so, based on what factors?
Can patients be expected to absorb PO acetaminophen as soon as they are tolerating a liquid diet following cardiac surgery?
What is the role of nursing-focused education to facilitate introduction of IV acetaminophen into a multimodal pain management protocol? And what degree of reduction of IV opioid use did you observe after this protocol change?
What is the mission statement of your ERAS group focused on cardiac surgery? And what is the foundational role of IV acetaminophen to push your ERAS goals, including reduced opioid consumption and reduced LOS, forward?
In your discussions with many other cardiac surgery centers focused on reducing opioid use and pushing forward ERAS-based protocols, what consensus, if any, have you seen regarding IV acetaminophen use?