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Game Changers in Surgery - June 2019 - Subscribe to Outpatient Surgery Magazine

Outpatient Surgery Magazine, providing current information on Surgical Services, Surgical Facility Administration, Outpatient Surgery News and Trends, OR Excellence and more.

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J U N E 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 2 7 U nderstanding and treating post-op pain is not simple, and there's no one solution. But there is a technology that is greatly underused in the management of perioperative pain: Contin- uous peripheral nerve blocks using the InfuBLOCK system. Right now, most facilities only offer single-shot nerve blocks if they offer blocks at all. That's not good care. Single- shot blocks are great for controlling pain during the pro- cedure and in the PACU, where experienced providers are available to assist. However, they regularly wear off in less than 24 hours, after the patient returns home. This places the patient in maximum pain with minimal med- ical knowledge close by. Invariably the recommendation is to rely on narcotics to control the pain. Based on recent publications, this puts about one in 20 patients at risk for developing an opioid dependency. I know what you're going to say. "We tried continuous peripheral nerve blocks. They didn't work. They're a has- sle to place, they leak and kink and the pumps fail. The patient often doesn't realize something is wrong until 6 or 8 hours later, and by that time it's too late." Four or five years ago, you would have been right. But times have drastically changed. • New "catheter over needle" products make placing cPNBs as easy as doing single-shot blocks. Providers who do single-shot blocks quickly get comfortable with cPNBs. These catheters are also much more secure than the old models, and leakage and kinking is rare. • It's no longer necessary to use the primitive elas- tomeric pumps that were at the root of so many of these problems. InfuBLOCK's electronic infusion pumps are much more accurate, customizable and dependable. Medication delivery is precise, and you can program these pumps to deliver custom boluses exactly when you want. They are outstanding data depots; they allow you to examine patient behavior and learn from it. I've never seen one of these pumps fail, but if it does, the alarm goes off and the patient can notify the provider in plenty of time. It's a win for everyone when a technology is less expensive, safer, and pro- vides better care. • Importantly, patients can call a highly-trained InfuBLOCK nurse at any time, allowing physicians to get their sleep. This is a game changer for our providers, who serve many rural and community hospitals. • As a bonus, using reusable InfuBLOCK pumps is much less expensive and much more environmentally friendly than using disposable elastomeric pumps. I converted to InfuBLOCK at an orthopedic hospital in Vail. Now I'm working on instituting these pumps throughout our nearly 60-hospital system. We convert- ed our first hospital last August; we saw dramatic differ- ences in VAS scores, and for the first 6 months, not a sin- gle doctor received a late-night phone call about pain. By year's end 6 more hospitals will be up and running. Thanks to this system, patients are experiencing tertiary- level post-op pain care at community hospitals. I'm hop- ing this movement will spread nationwide. Two million Americans are addicted to prescription pain killers and more than 33,000 overdose and die each year. We need to do more. Too often, our answer has been: "Take two oxycodones and call me in the morning." cPNBs are not the entire answer, but they are a signifi- cant component. Thanks to InfuBLOCK, they're now fea- sible for every facility, including yours. Dr. Nelson, who serves as Chief Quality Officer at MedStream Anesthesia, speaks and writes about periop- erative pain management and throughput improvement. Let's Stop Single-Shot Nerve Blocks cPNBs are easier with the InfuBLOCK system. Lindsey Nelson, MD, Hendersonville, NC Sponsored by SPECIAL ADVERTISING SUPPLEMENT Dr. Nelson goes over post-op instructions for the INFUBLOCK pain pump.

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