Working with the community... for a healthier community.

Pain Management And Anesthesiology


Successful Outpatient Procedures Rely on Compassionate Care and Expertise Of Certified Registered Nurse Anesthetists


Submitted by Mississippi Valley Surgery Center


Anesthesia plays a crucial role in every outpatient surgery. While that may seem obvious, there’s more that goes into anesthesia than just putting a patient to sleep for a procedure. Certified registered nurse anesthetists (CRNAs) are tasked with managing pain before any surgery even begins.

“Patients recover quicker because our proven anesthetic techniques lead to better outcomes,” Sarah Butcher, CRNA at Mississippi Valley Surgery Center, said. “And that’s why more procedures can be done in an outpatient facility.”

CRNAs are advanced practice nurses with specialized graduate-level education in anesthesia care. They administer anesthesia for all types of surgical cases, from the simplest to the most complex. CRNAs are also the primary anesthesia professionals in rural America.

Sarah Butcher has worked at MVSC for 18 years. After starting her career working in a hospital intensive care unit, she decided to further her education and explore anesthesia. She called it the perfect way to build on her critical care experience.

“What I always tell the patients is that I am going to treat them like I would a family member because I want them to have the best outcome,” she said. “I am upfront and honest with them, and I think people really respond to open communication.”

The entire team of certified registered nurse anesthetists at MVSC rely on that open communication to build trust with their patients quickly. While patients may visit their doctor several times leading up to a procedure, they often meet their anesthetist on the same day as their surgery. It’s also the CRNA’s responsibility to stay with the patient throughout the procedure, monitoring vital signs and making sure they’re as comfortable as possible going into recovery.

“We talk to patients about their options, and we make sure that they’re well-informed, so we can make decisions together,” Sarah explained. “It’s one part education, one part reassurance that they’re in good hands.”

Since 1996, MVSC has provided a convenient and patient-centered facility for outpatient surgical services. The MVSC team performs approximately 9,000 procedures each year and employs close to 100 clinical and non-clinical personnel. Today, MVSC is Iowa’s only AAAHC Advanced Orthopaedic and Spine Certified surgery center. AAAHC accreditation requires MVSC to participate in ongoing self-evaluation, peer review and education—demonstrating its commitment to high-quality health care and high standards.


Addressing Patient Nerves and Concerns

Experienced anesthetists say that patients are often more nervous about the anesthesia than they are about the procedure itself. Some have had bad experiences in the past, or they know other people who have had bad experiences. At MVSC, those concerns are addressed by the center’s eight CRNAs.

The most appropriate anesthetic technique depends on the type of surgery planned. Some procedures can be done with only light sedation, like cataract surgery. Other procedures call for use of a regional block and deep sedation, while some often require general anesthesia.

“The regional blocks we do are for postoperative pain control,” Sarah said. “With the pain block in, we can use fewer narcotics and other mediations that can have unwanted side effects.”

For example, a patient getting shoulder surgery would need to be fully asleep. But adding the block allows for pain management after the patient wakes up. It offers a significant amount of time—up to 24 hours—when the patient will have little to no pain in the shoulder. It allows them to get home, get settled, and start taking their oral pain medication.

“The block gradually wears off, and it serves as a segue to postoperative pain control,” Sarah said. “By using less anesthetic initially, we decrease the amount of nausea and/or vomiting, allowing patients to get home quicker. I have found that for most patients, that’s what’s important to them.”


Successful Patient Outcomes

While it is normal to feel a little groggy and to have some discomfort post-anesthesia, an anesthetist’s job is to make sure it’s at an acceptable, safe level for patients to go home. MVSC’s CRNA team credits the good working relationship they have with the center’s surgeons for successful outpatient outcomes.

“We’re really in tune with the surgeons, especially because of the ongoing opioid crisis,” Sarah said. “We want patients to limit the use of narcotics. In the short term, narcotics can have lots of complications that keep patients from being able to go home, such as nausea and/or prolonged sedation. Long-term, we also know there is a risk for addiction.”

The CRNA team encourages patients to ask questions and be open with their providers about any concerns they have. For Sarah, providing care and reassurance is her favorite part of the job.

“It’s great to meet people and build a trusting relationship with them,” she said. “I feel very humbled by the job I get to do. Patients may not remember our names, but they remember if they had a good experience with anesthesia or not.”



Anesthesia at a Glance

  • General anesthesia: Used for major operations like shoulder surgery that causes you to lose consciousness.
  • IV/monitored sedation: Often used for minimally invasive procedures like colonoscopies with a sedation range from minimal to deep.
  • Regional anesthesia: Often used during arm, leg, or abdomen surgeries—numbing a large part of the body but allowing you to remain aware.
  • Local anesthesia: Used for small procedures like mole removals or stitches by simply numbing a small area while keeping you awake and alert.



              To learn more about Mississippi Valley Surgery Center’s anesthesiology team, go to or visit the center’s Facebook page at