To the Editor:

I’m writing in regard to the excellent article, “Chronic Pain Can Be Limited by Anesthesia Choice” by Damian McNamara, which was published in the February 2013 edition of General Surgery News [page 1].

I am a general surgeon who has practiced “preemptive analgesia” for years. I inject 0.5% Marcaine [Hospira, Inc.; bupivacaine and epinephrine injection] into all the layers of the tissue on which I’m operating before making my incision. Studies have shown that this practice diminishes the production of substances at the cellular level that contribute to long-term postoperative pain. Before closing the wound, I again inject Marcaine into all the tissue layers. I also use pain pump catheters in all patients who have wounds large enough to contain them. Hopefully, the new drug Exparel [Pacira Pharmaceuticals, Inc.; bupivacaine liposome injectable] may obviate the need for pain pumps.

If you ask our hospital’s postoperative nursing staff which doctor’s patients have the least amount of pain, they’ll all tell you they’re mine. I’ve been in practice for more than 37 years, and I continue to be amazed by how little care and attention most surgeons give to their patients’ postoperative pain, especially long-term pain.

Richard A. Wiethoff, MD
Seymour, Ind.