Dr. Peter Attia

I mean, this is a very complicated thing to do, but if you want to know the answer, that's kind of the way you want to do it.

I mean, this is a very complicated thing to do, but if you want to know the answer, that's kind of the way you want to do it.

Even in the world we live in today, where we understand that for a non-zero, potentially non-trivial segment of the population, the introduction to opioids that ultimately destroys people's lives is delivered by the medical system.

Even in the world we live in today, where we understand that for a non-zero, potentially non-trivial segment of the population, the introduction to opioids that ultimately destroys people's lives is delivered by the medical system.

This is a little unrelated, but I remember this when I was in residency. There was one of the attendings, and I don't even remember who it was, But he had this belief, he used to quote this study, and I don't remember it, but it said that if you injected bupivacaine into the injection site, sorry, the incision site. So I'm going to make a midline incision, draw my little line, inject bupivacaine.

This is a little unrelated, but I remember this when I was in residency. There was one of the attendings, and I don't even remember who it was, But he had this belief, he used to quote this study, and I don't remember it, but it said that if you injected bupivacaine into the injection site, sorry, the incision site. So I'm going to make a midline incision, draw my little line, inject bupivacaine.

So for the listener, this is a long acting sodium channel blocker. Wait for... Some long period of time, like 10 minutes, then make the incision, go about, do your surgery, and then immediately give that patient acetaminophen and ibuprofen immediately post-operatively and keep them on it around the clock. You could eliminate opioid use.

So for the listener, this is a long acting sodium channel blocker. Wait for... Some long period of time, like 10 minutes, then make the incision, go about, do your surgery, and then immediately give that patient acetaminophen and ibuprofen immediately post-operatively and keep them on it around the clock. You could eliminate opioid use.

And he was convinced that the only reason surgeons didn't want to do this was because nobody wants to inject and stand there for 10 minutes with your thumb up your ass waiting for the bupivacaine to seep into the tissues. And maybe it's anecdotal, but it really seemed to work.

And he was convinced that the only reason surgeons didn't want to do this was because nobody wants to inject and stand there for 10 minutes with your thumb up your ass waiting for the bupivacaine to seep into the tissues. And maybe it's anecdotal, but it really seemed to work.

Like it really seemed to work that you would do this inguinal hernia repair or at the time some small laparotomy or whatever it was, anything. And if you were willing to put that bupivacaine in and sit there and wait And I'm trying to think, we might've used epi with lidocaine as well. So it might've been a little epi with lidocaine plus bupivacaine or something like that.

Like it really seemed to work that you would do this inguinal hernia repair or at the time some small laparotomy or whatever it was, anything. And if you were willing to put that bupivacaine in and sit there and wait And I'm trying to think, we might've used epi with lidocaine as well. So it might've been a little epi with lidocaine plus bupivacaine or something like that.

And you had to be super due diligent about keeping the acetaminophen and ibuprofen levels up. Have you ever heard of anything like that?

And you had to be super due diligent about keeping the acetaminophen and ibuprofen levels up. Have you ever heard of anything like that?

Which means you have to use less BOVI, which means less tissue damage. Yes. Maybe he was using epi with bupivacaine. I don't remember. But there's something there.

Which means you have to use less BOVI, which means less tissue damage. Yes. Maybe he was using epi with bupivacaine. I don't remember. But there's something there.

Yeah. But look, a 50% reduction in opioid requirement postoperatively would be enormous. Huge.

Yeah. But look, a 50% reduction in opioid requirement postoperatively would be enormous. Huge.

Do patients receive that well? That's a hard discussion to have with a patient, I would imagine.

Do patients receive that well? That's a hard discussion to have with a patient, I would imagine.