Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
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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.
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.
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.
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.
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.
Yeah, that makes sense.
So let's talk about a couple other things that are related to this, but distinct. Let's talk about acupuncture. What do you know about it? Well, let's talk about through the lens of chronic pain. Yeah, yeah, yeah. All right. Clinically.
And you say wallet biopsy because the insurance doesn't typically cover it?
So Medicare is covering something commercial payers are not? Well, it's possible. Okay.
So notwithstanding, I like the idea of a wallet biopsy. I hadn't heard that before. In your experience, where do you see it being most successful? What type of pain? What type of clinical presentation?
Puncture, but not in the appropriate spot?
How do we think of acupuncture differing from dry needling?
In California, I think it's not legal to dry needle, but you can acupuncture. I even understand the difference.
Maybe. I see acupuncture refers to just going after a nerve specifically.
Okay. Next question on chronic pain. What is the role of cannabis in your experience here? Is it friend or foe? And again, I'm sure there's a nuanced answer.
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