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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M A R C H 2 0 2 1 • O U T P A T I E N T S U R G E R Y . N E T • 3 1 aren't purchased; and the technical skill of an anesthesia provider is needed to properly place the catheter. Patient and procedure selection are criti- cal when deciding to employ pain pumps. The devices are ideal for procedures that have an expected recovery of more than two to three days. Examples: orthopedic proce- dures involving aggressive manipulation or repeated manipulations during the first few days post-op, or recoveries requiring patients to return for intensive physical rehabilitation the day after surgery. Opioid-tolerant patients, including those who already take narcotics to manage ongo- ing pain disorders, are also good candidates for pain pumps, as are patients with significant comorbidities such as respiratory issues, high BMIs and pulmonary problems. Catheter placements are best saved for patients who are engaged in their own care, who understand the detailed instructions on how to monitor the catheter and pump, and who have a good support structure at home in case any- thing goes wrong. Around-the-clock patient support is vital to the success of a continuous nerve block program. Nurses or physicians must be available to get on the phone with patients who could experience unlikely problems such as kinking, leaking, clogging or pump failure — all of which could result in the patient not getting the anesthetic needed to prevent their post-op surgical pain. Patients need to be told before discharge, in great detail, how and when to take the catheter out and what to look for while it's still inside of them. Follow up this in-person expla- nation with detailed written discharge instructions. Facilities that run continuous nerve block programs must have the buy-in of the nursing staff and a team of doctors who are willing to take calls at all hours to troubleshoot potential problems with patients. In a perfect world, the support team would call patients proactively to make sure the devices are working as they should. In addition to technical troubleshooting, patients and the medical team must be on the lookout for infection, bleeding, migration of the catheter, or the catheter getting ripped or torn inside the patient. Pain pump designs have improved over the years, and potential malfunctions that discouraged providers from giving them to patients have decreased significantly. Disposable elastomeric pumps have a bulb full of anesthetic and deliver a moderate yet consistent amount of medication until the bulb is empty. They're relatively easy for patients to use and some have patient-controlled features that deliver additional anesthetic in the event of breakthrough pain. Any sort of patient-con- trolled therapy that gives the patient more autono- my is helpful — for the appropriate patient. Electronic pain pumps provide more targeted pain control. The medicine fills the incision space via preprogrammed intermittent boluses. Many of the newer electronic devices have sensors that detect medication delivery interruptions and sound alarms for patients and send alerts to providers if something goes wrong. Safe and pain-free recoveries The more involved the surgery, the more pain it's likely to cause. Providers can manage significant post-op pain with opioids, but are trying to avoid that whenever possible for the obvious reason of not wanting to exacerbate the nation's ongoing addiction crisis, as well as the fact that narcotics cause nausea, vomiting and constipation — adverse events to avoid after surgery. Multimodal analgesia, OPIOID-SPARING Regional anesthesia can produce short- and long-term pain control for same-day surgery patients. Ed Mariano