A P R I L 2 0 1 7 • O U T PA T I E N TS U R G E R Y. N E T • 1 2 7
Pain pumps extend the analgesic
effects of regional blocks and may be a
better pain-control option than opioids.
"It's technically a little more complicat-
ed to use pumps, because proper
catheter placement is dependent on the
skills of the anesthesia provider, and
the catheter can become dislodged,"
says Dr. Wu. "But when catheters are
placed properly, pain pumps are 85 to
95% effective in managing pain."
Do smarter pumps that allow for pre-
set amounts of local anesthetic to be
delivered at specified times represent the
future of post-op pain management? Or
will there be a new formulation of local
anesthetic delivered with a single shot
that can provide the same extended
duration of analgesia? Both trends are
worth watching, but for now, combining
multiple therapies reduces the required
dose of individual agents to provide bet-
ter pain control with fewer drug-related
side effects. And don't ignore the effec-
tiveness of tried-and-true pain-relieving
methods, points out Dr. Carr. He reminds
you that placing a bag of ice on the surgi-
cal site provides the simplest possible
relief from surgery's most complicated
consequence.
OSM
gabalin can be consid-
ered for multimodal
post-operative analgesia
and are associated with
lower opioid require-
ments after surgery.
Typical doses are 600 or
1200 mg of gabapentin or
150 or 300 mg of prega-
balin, administered 1 to 2
hours before surgery.
• Rely on regional.
Use continuous local
anesthetic-based
regional anesthesia
when the need for anal-
gesia is likely to exceed
the effect of a single
injection. If you send
patients home with
ambulatory infusion
pumps, require that they
monitor the pumps for
failure and are aware of
the signs, symptoms
and emergency man-
agement protocols of
local anesthetic toxicity.
— Daniel Cook
