The limiting factor in discharging patients hours after they've undergone painful procedures is managing their pain once they're home. That's where pain pumps come in. As more invasive procedures continue to migrate to outpatient facilities, the demand for pain pumps is only going to grow.
At the Andrews Institute Ambulatory Surgery Center, we've been sending patients home with them for 10 years and have had tremendous success. There's a learning curve for providers, but once you've mastered the skills needed to place catheters in the right locations, pumps can be a terrific alternative to the opioids-and-good-luck approach of managing post-op pain.
Elastomeric or electronic?
Which pump should you choose? There are several factors to consider. There are 2 distinct types. Elastomeric pumps slowly deflate on their own, pushing anesthetic through an IV-type tube to continuously bathe nerves with soothing relief. Electronic pumps use batteries or external power sources to provide the same relief. Elastomeric pumps, and some electronic models, are disposable and therefore typically more expensive. When patients equipped with non-disposable electronic pumps complete their treatment, they can mail the pumps back to their providers.
In either case, one of the big determining factors in which type you purchase is likely to be how much control you want your patients to have. Many providers and facilities set a certain infusion rate and literally take away the key. They won't even let nurses, let alone patients, change the rates. But if you take that approach, you limit your ability to customize care for each particular patient.
Does the pump have a bolus option? I prefer to use programmable pumps and allow patients the option to adjust infusion rates within certain parameters and also to give themselves boluses when they feel the need. In addition to helping with breakthrough pain, the bolus provides more spread in the tissue plane, so the pump can do a better job of saturating a larger area. That's really useful for any block where the catheter isn't right next to the nerve, such as an adductor canal or an infraclavicular block, where you have 3 cords of the brachial plexus bundled around the axillary artery. With elastomeric pumps, the extra push provided by the bolus may be a little slower and weaker, so it may not provide the same spread as their electronic alternatives.