Improve pain control, cut SSIs with one product

Study shows pain pump's positive effect

Extra help in reducing surgical site infections (SSIs) can come from an unlikely source: a pain management pump. In a study presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy in Chicago, researchers presented information showing a decrease in surgical site infections for patients using an in-the-wound pain control pump.1

Although the study looked at 289 inpatients receiving colorectal surgery, the results are significant for outpatient surgery programs because the use of in-the-wound pain management pumps is common for many outpatient procedures, says Jay Singh, MD, director of surgical residency at Piedmont Hospital and professor of surgery at Emory University, both in Atlanta. While outpatient procedures are generally considered to be "clean, the fact that patients are discharged to home on the day of surgery increases the need to consider every opportunity to reduce SSIs, he says.

Singh was the lead investigator of the study that compared the rate of SSIs in patients receiving an On-Q PainBuster with ON-Q SilverSoaker Antimicrobial Catheter [I-Flow Corp., Lake Forest, CA] to the rate of SSIs in patients receiving traditional narcotic pain management via patient-controlled analgesic or epidural. In the study, patients receiving pain management through the pain pump had a significantly lower SSI rate; the SSI rate for the pain pump patients was 6.6%, compared to a rate of 14.6% for patients receiving traditional pain management.

Deciding to evaluate the pain pump as a reason for lower SSIs was the result of secondary observations during previous studies that evaluated the device's affect on hospital length of stay and effectiveness of pain management, says Singh. "We knew that SSIs were the cause of longer lengths of stay, but we were surprised to see a connection between the pain pump and fewer SSIs, he says.

There are several reasons that the in-the-wound pain pumps reduce the risk of infections, says Singh. "Most people's first reaction is that inserting a catheter into the wound is another way to introduce bacteria, he says. "In reality, we discovered that the pain pump reduced pain to the point that patients were ready to move around earlier. Ambulation increased blood flow to the wound, which increased the speed of tissue regeneration, Singh says. A wound that heals quickly is less likely to become infected, he points out.

Narcotics also are known to negatively affect the immune system, and the anesthetic used in a pain pump actually boosts immune systems, says Singh. Without a suppressed immune system, the patient is less vulnerable to infection, he adds.

Another factor that contributed to the significant reduction in SSIs in the pain pump group is the silver soaker system patented by I-Flow Corp., says Singh.

"Silver is known to have antimicrobial properties, but we did not test a pain pump that does not use a silver-coated catheter, so we can't know for sure if this was a significant factor, he says. A follow-up study that compares silver vs. nonsilver catheters is logical, Singh adds.

In outpatient surgery settings, the most likely procedures for in-the-wound pain pumps would be inguinal hernias, laparoscopic hysterectomies, and mastectomies, says Singh. "Orthopedic procedures such as knees, shoulders, and any procedure using graft material are also ideal for pain pumps, he says. "It is especially important to avoid infecting any hardware that is implanted because an infection can require removal of the implant.

Surgeons at the Surgery Center of Santa Rosa (CA) have used pain pumps since September 2004, says Michele Eichner, RN, director of nursing for the center. "We started with a general surgeon who used the pump for hernias and a hand surgeon, but now the pump is predominately used by some of our orthopedists, she says.

Results of the SSI study may help Eichner promote increased use of the pump. "Of the 12 orthopedists on staff at the center, only seven use the pump, says Eichner. "The other five orthopedists are concerned about infection from the catheter inserted in the wound.

Although she has pointed out that in-the-wound pain pumps have been used for years at the center with no incidence of surgical site infections, the physicians' minds have not changed, she says. A formal study, with documented results, may provide more ammunition, she adds.

The catheter takes only a couple of minutes to place, so the overall time of surgery is not affected, Singh says. "The pump contains a three- to five-day supply of anesthetic, then the patient returns to the physician's office for removal, he says. In reality, the catheter is simple to remove, and a patient can do so at home, Singh says. "Most surgeons, however, want to see the patient to evaluate the wound, he adds.

There is not a lot of staff education required to use the pain pump, says Eichner. "There is a small amount of assembly in the operating room, and you do have to document insertion of the pump and the medication, but it is not difficult, she says.

Patient education occurs in the recovery room, and patients are not uncomfortable with the idea of the catheter, says Eichner. "The idea of improved pain control is very attractive to all patients, she adds.

The ON-Q pump is reimbursed by most insurance companies and Medicare to treat post-surgical pain under the hospital outpatient prospective payment system (OPPS), but Eichner participates in a program in which her vendor, I-Flow Corp., handles all insurance claims. "I just order the pumps I need, then send the documentation to the company and they handle everything, she says. "It's a very efficient way to offer a good service to patients at no cost.

Reference

  1. Singh J, Hum M, Liberman H, et al. Multicenter infection surveillance study comparing two types of postoperative pain management, surgical site using ON-Q SilverSoaker and local anesthetics vs. systemic narcotics following colorectal procedures. Presented at 47th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago. Sept. 9, 2007.

Sources/Resources

For more information about pain pumps and reduction of surgical site infections, contact:

  • Jay Singh, MD, Piedmont Colorectal Associates, 35 Collier Road N.W., Atlanta, GA 30309. Telephone: (404) 351-7900. E-mail: jaysinghmd@yahoo.com.
  • Michele Eichner, RN, Director of Nursing, Surgery Center of Santa Rosa, 1111 Sonoma Ave., Lower Level, Santa Rosa, CA 95405. Telephone: (707) 578-4100. E-mail: michele.eichner@scasurgery.com.

The following companies offer in-the-wound pain control pumps: