Dr. Vincent Galan: Pain management advancements shaping the ASC arena

The healthcare market has witnessed advances in both surgical techniques and pain management, which have propelled surgeons to perform more cases in ASCs.

Vincent Galan, MD, medical director of Pain Care and president of the Center for Pain and Spine, both in Atlanta, highlights how pain management has advanced to allow surgeries to move to ASCs and the physician's role in the changing healthcare arena.

Question: How have advances in pain management techniques allowed surgeries to move to the ASC setting?

Dr. Vincent Galan: Advances in pain management have allowed for different patients, which before needed surgeries in the hospital setting, to [move to] the outpatient setting.

An example is spinal stenosis for which there are two products in the market, Superion and MILD, [that allow providers] to treat this mostly elderly population, instead of [requiring] a posterior decompression. Also, endoscopic discectomy is an outpatient surgery done under local anesthesia and monitored anesthesia care.

Continuous infusions allow patients to be sent home, and regional blocks for shoulders have also helped speed up discharges. Also, transversus abdominis plane blocks for hernia surgery [have allowed surgeries to move outpatient]. The use of ultrasound has allowed for more specific peripheral nerve blocks with a lower concentration of local anesthetics, increasing safety and efficacy.
Q: What is a patient's role in managing their pain and how can ASC staff effectively manage a patient's expectations for pain?

VG: Expectations are based on perception. An honest discussion of the surgeon and anesthesiologist with the patient is needed and starts with the preoperative visits.  
Q: How can pain management specialists succeed in healthcare's rapidly evolving environment? How will their role change in the coming years?

VG: We are seeing more minimally invasive procedures and an increase in outpatient procedures. Pain management doctors, due to our expertise in the use of fluoroscopy, can perform some of these procedures from more invasive settings to less invasive areas, [one] example [being the] evolution of kyphoplasty from hospital to ASC. Also minimally spinal decompression procedures like MILD, endoscopic discectomy and superion for spinal stenosis and radiculopathies [are also performed less invasively].  

Learn more from Dr. Galan at the 24th Annual Meeting: The Business and Operations of ASCs in October 2017. Click here for more information.

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