When you send a patient home with a pain pump, there's a lot that can go right and a lot that can go wrong. Under the best circumstances, the patient's pain will be minimized, and you won't have to spend the next 3 days fielding phone calls, dealing with complaints or troubleshooting.
But the potential for hassles makes some physicians reluctant to use pumps, regardless of the potential benefit to patients. Like most people, anesthesiologists, once they're finished in the OR, would prefer to go home and not have to take any calls. They don't want to have to deal with messages from patients saying, "My catheter's leaking" or "My arm is numb, what can I do?"
It's a challenge for pump manufacturers, who are working to overcome that reluctance (see "5 Pain Pump Options" on page 50). And those manufacturers are also coming face-to-face with a relatively new challenge, in the form of time-release single-shot blocks designed to relieve pain for several days. Those, too, may discourage anesthesiologists and surgeons from using pumps, the rationale being: Why put catheters in and deal with the potential post-op hassles when I can put one block in and be done?
Flexibility of pumps
Even if a nerve block can last for 3 days — and the data isn't convincing yet — that's not always a positive thing. Inevitably, some patients will call and say they hate the sensation of having an arm that feels like a dead fish. They'd rather have the pain. But with a block, once it's in, you've bought the ticket. There's no way to adjust it.
Pumps, on the other hand, offer much more flexibility. You can turn them off, turn them down or stop them early. When patients call our facility saying they don't like the sensation, we can tell them to clamp their pumps. The flow of local anesthetic stops, the numbness wears off a little bit and they start to get some feeling back. Then, if they decide the pain is even less preferable, they can just unclamp the catheter and let the flow of anesthetic resume.