in these individuals, according to Roman Margulis, MD, an assistant
site director at Montefiore Health's Joint Replacement Center in the
Bronx, N.Y.
"CNBs also work well for patients with respiratory issues, and other
worrisome comorbidities such as high BMIs and pulmonary issues —
indications the patient won't tolerate opioids well," he says.
Clinical upgrades
Continuous catheter designs have progressed over the years, making
them more appropriate to send home with patients. While some physi-
cians once had concerns about using the systems due to potential
kinking, leaking, clogging or pump failure, the delivery systems today
are made of more resilient materials that are not as prone to those
issues as they were in the past.
• Better pumps. Elastomeric pumps are simple devices that are
easy for patients to use. Some models feature patient-controlled
medication boluses for managing breakthrough pain. More advanced
electronic pumps provide better control of medication delivery rates
and have the ability to automatically administer pre-programmed
intermittent boluses. Some pumps can also be programmed to give
the patients the ability to self-administer boluses within pre-set
parameters.
"While an elastomeric pump delivers a consistent, moderate
amount of analgesia, some experts believe electronic pumps offer
better, more controlled pain control because the medicine fills the
incision space when you want it to instead of continuously run-
ning at a higher volume," says Emily Winchester, RN, a block nurse
at the San Francisco (Calif.) Surgery Center.
Electronic pumps have integrated sensors that detect if medication
delivery is interrupted and alarms that alert the patient to the mal-
9 8 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • N O V E M B E R 2 0 1 9
