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Archive Hot Technology 2017

A Smarter Approach To Post-Op Pain Management

The newest infusion pumps offer high-tech solutions to surgery's age-old problem.

Daniel Cook

Daniel Cook, Editor-in-Chief


computerized pump GET WITH THE PROGRAM Computerized pumps let providers deliver specific amounts of local anesthetic to the surgical site.

Elastomeric pain pumps work just fine. But why settle for sending patients home with a bag full of local anesthetic that you hope delivers the right amount of numbing relief when you can program a "smart" ambulatory infusion pump to deliver the exact right dose at the exact right time and collect patient-use data that measures an anesthesia provider's ability to deliver effective pain management?

"That information lets anesthesia groups quantify their value when negotiating contracts with the facilities where they provide services," says Nabil Elkassabany, MD, MSCE, an assistant professor and the director of orthopedic anesthesiology at the University of Pennsylvania in Philadelphia, Pa. That benefit cuts both ways: You can use the data that smart pain pumps collect to measure your anesthesia team's performance. Smart, indeed.

Dialing up data
Dr. Elkassabany has seen his pain control program evolve from the use of elastomeric pumps to computerized models with the capability to deliver a more exact infusion rate of local anesthetic. "The plus-minus range around the intended amount becomes very narrow, which helps a lot," he says. "If a patient is also able to self-administer medication boluses during a time specified by providers, overall pain control is much more effective and satisfaction scores increase."

The first 72 hours are the most critical for pain control, says Dr. Elkassabany. "If we're able to get patients comfortably through that period, we're providing them with a great service," he says. You can program some of the newest pain pumps to delay the onset of anesthetic, so the first dose is delivered around the time when the local block is wearing off and the overall pain control period is extended. But Dr. Elkassabany says not all of a pump's bells and whistles are needed, and prefers to send patients home with a device that's already in action. "It's reassuring to see that it's delivering local anesthetic before patients are discharged," he says. "It's much more difficult to troubleshoot malfunctioning pumps when patients aren't in the facility."

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