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Because orthopedic procedures can result in a great deal of postoperative pain, many orthopedic surgeons have looked at delivering pain medication directly to the surgical site, even after the patient leaves the same-day surgery facility.
Pumps that deliver anesthetics through a catheter directly into the surgical site are being used to relieve post-op pain for orthopedic and other surgery patients, says Stephen Lucie, MD, an orthopedic surgeon at the Jacksonville Orthopaedic Institute in Jacksonville, FL.
"I’ve been using the pump for 18 months on my anterior cruciate ligament [ACL] reconstruction and rotator cuff repair patients," says Lucie. "One advantage is that 100% of my ACL patients are now same-day surgery rather than 50% same-day surgery and 50% 23-hour stay patients," he points out. Patients undergoing rotator cuff repair also are 100% same-day surgery since there is no need to keep them for 23 hours to manage the pain, he adds.
Not only are patients sent home earlier, but the delivery of the anesthetic, usually marcaine, reduces the need for narcotic medications, adds Lucie. The catheter is inserted by the surgeon in the operating room and stays in place for 24-48 hours, he says. "It is usually removed at the patient’s first post-op visit to the surgeon or the first post-op visit to the physical therapist." Pumps for Lucie’s patients are removed by a nurse or the physical therapist, both of whom have been trained to remove the catheter, he adds.
Some surgeons see the introduction of a catheter into the surgical site as a potential source of infection, but Lucie says he has seen no increase in surgical site infections in his patients as a result of the catheter. Disconnection of the tube is another potential problem, but again, Lucie says it has not been a problem in his practice.
The pumps, which range in price from $125 to more than $300, have not created any reimbursement problems, says Mary Fischer, RN, director of outpatient surgery, preadmission, and testing for Borgess Medical Center in Kalamazoo, MI. "As with any supply in same-day surgery, we constantly evaluate reimbursement in order to identify potential problems early, "she says. "We may look at including the cost of the pump in a package price if needed."
The cost savings of the pumps are important, adds Fischer. "We cut down on the amount of pain medication needed, and patient satisfaction is high because they are not dealing with a lot of pain," she points out.
If a same-day surgery manager is looking at adding pain pumps as a pain-control measure, he or she should look at the procedures done most often within one specialty for a pilot, suggests Fischer. "We started using pain pumps only with our ACL patients about two years ago, then expanded its use to patients undergoing shoulder surgery and arthroscopy once we were comfortable with the pump’s use and results," she explains.
In addition to pumps that work well for orthopedic patients, there also are pumps that are appropriate for use after some gynecological procedures or hernia repair, she adds.
Patient education starts in the physician’s office, and patients are given brochures and telephone numbers in the event they have questions, says Fischer. "We also ask about the pump’s performance when the nurse calls the day after surgery," she adds.
Staff education consisted of inservice classes for physicians and operating room staff as well as demonstrations and videos. Because the surgeon fills the pump with the anesthetic, there was no need to cover that topic in the orientation to the device, adds Fischer.
Same-day surgery managers need to prepare guidelines and policies regarding the pump before implementing its use, says Fischer. "Be prepared to change and update these guidelines as you learn more about the device because this is still so new that we are all blazing our own trails," she says.
For more information on pain pumps, contact:
• Stephen Lucie, MD, Jacksonville Orthopaedic Institute, 1325 San Marco Blvd., No. 200, Jacksonville, FL 32207. Telephone: (904) 346-3465.
• Mary Fischer, RN, Director of Outpatient Surgery, Preadmission, and Testing, Borgess Medical Center, 1521 Gull Road, Kalamazoo, MI 44001. Telephone: (616) 226-7054.
These vendors offer pain pumps that are appropriate for same-day surgery procedures:
• DjOrthopedics LLC, 2985 Scott St., Vista, CA 92083-8339. Telephone: (800) 336-6559 or (760) 727-1280. Fax: (760) 734-5608. Web: www.donjoy.com.
• Sgarlato Laboratories, 656-B N. Santa Cruz Ave., Los Gatos, CA 95030. Telephone: (800) 421-5303 or (408) 399-4638. Fax: (408) 354-4922. Web: www.sgarlatolabs.com.
• Stryker Instruments, 4100 E. Milham Ave., Kalamazoo, MI 49001. Telephone: (800) 253-3210 or (616) 323-7700. Fax: (800) 999-3811 or (616) 323-2887. Web: www.strykercorp.com.
• Breg, 2611 Commerce Way, Vista, CA 92083. Telephone: (760) 599-5706. Fax: (760) 599-3030. Web: www.breg.com.