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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5 9 D E C E M B E R 2 0 1 4 | O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E 1. Shorten the steep learning curve. It takes considerable skill and intense training to place pain catheters. Our anesthesia providers prepare by placing single-shot blocks for several months. Think of pain catheters as extensions of single-shot blocks, but much more complex. You're using a much larger needle to facilitate threading the catheter once it's in the correct position: an epidural-sized needle (usually 18-gauge) vs. a 22-gauge needle for most single-shot blocks. To avoid nerve damage, you should always see the tip of the larger needle on the ultrasound as you advance it. 2. Pain catheters require extra time. Continuous blocks take much longer to place than single-shot blocks. It could take a novice as long as 30 to 40 minutes. A more experienced practitioner can place a catheter in 15 minutes or so. I strongly advise that you place catheters in a separate block room or in the pre-operative hold- ing area, never in the OR. For efficiency's sake, your goal should be to make sure that the patient has a catheter in place as soon as the OR is ready so that you're not eating into room turnover time or delaying the start of the case. For preemptive analgesia, it's obviously prefer- able to have the catheter in place before surgery, but you could always place it afterward to keep the schedule moving. 3. Getting reimbursed. It's tough to defend doing so many pain catheters to the board of our anesthesia group, because it's a financial loss. We stress that it's a value-added service and focus on the excellent patient outcomes, but the minimal reimbursement is frustrat- ing. In the Philadelphia area, we receive about $50 for a continuous block, which is almost insulting. (We get around $100 for a single-shot block.) It costs us around $350 for the materials needed to place a catheter and for the pain pump that the patient goes home with. P O S T - O P P A I N