Becker's ASC Review

71 Executive Briefing Sponsored by: A s America's other epidemic, the opioid crisis, continues to inflict societal and economic damage on the U.S. healthcare industry, hospitals and clinicians are seeking new cost-effective and accurate ambulatory infusion pumps that can reduce and, in some cases eliminate, the need for postoperative opioids. The decentralization of healthcare has enabled a growing number of patients to recover from surgical procedures with home infusion therapy, a global market that is expected to reach $41.6 billion by 2027, according to Research And Markets. Home infusion when used with cGMP manufactured medicines, provides a safe, cost-effective approach to IV therapy that can contribute to improved quality of life for patients. Costs associated with outpatient surgery were shown to be consistently lower than services provided in a hospital setting, with savings ranging between $1,928 and $2,974 per course of treatment. As healthcare providers work to reduce opioid prescriptions and succeed under value-based reimbursement models, leading organizations are leveraging a new infusion pump solution to deliver safer pain management, reduce costs and shorten length of stay, while improving outcomes and the patient experience. Until now costs associated with outpatient ambulatory pain pumps in the ASC space have been considered a drain on supply budgets, having a negative impact on profitability and a low ROI. Finally the search has ended for a turnkey solution that is accessible, easy to use and affordable for any facility striving to deliver a more effective opioid avoidance strategy for the patients they serve. A new era of postoperative pain management Duke University Medical Center (DUMC) in Durham, N.C., has been using continuous catheters for home infusions for orthopedic patients, such as shoulder and knee replacement patients, for a couple of decades, said Jeff Gadsden, MD, anesthesiologist and division chief for orthopaedics, plastics and regional anesthesiology at the hospital. Previously, the hospital utilized elastomeric pumps to deliver local anesthetic to patients postoperatively, but was limited by the technology in two key areas: "One of them is that the rate is difficult to control precisely, and the reservoir volume is also limited," Dr. Gadsden said. DUMC sought a solution to these drawbacks and in 2020 implemented InfuTronix Solutions' Nimbus II PainPRO electronic ambulatory pain pump. The new technology enables clinicians to extend the duration of pain control by delaying the start of therapy for up to 24 hours, draws the local anesthetic from a medication bag with flexibility to program a larger infusion volume, and features a pre- programmed automatic bolus menu to customize pain management solutions. "The Nimbus pain pump provided us with an increased reservoir capacity of up to one liter more volume, which gave a lot of our patients up to five days of relief with the catheter," Dr. Gadsden said. "And because it's an electronic pump, we can program it to run in different modes, in terms of a patient bolus or an automatic bolus, where the patient doesn't have to push a button or wait for the next hour for relief to carry on." "Every day you can delay a patient from having to take their oxycodone after their operation is a victory," he added. The ability of the Nimbus pain pump to provide relief for patients for up to five days is one of the device's most innovative features. It also enables patients to increase their amount of regional anesthetic if they experience discomfort, said Christian P. Christensen, MD, an orthopedic surgeon specializing in outpatient and rapid recovery hip and knee replacements at Bluegrass Specialty Surgery Center in Lexington, Ky. Safeguards installed in the technology, that include Min- Max volume limits can be set based on patient specific information to prevent individuals from receiving more than the recommended amount of local anesthetic per hour. "It reduces the risks of a lot of complications associated with narcotics, such as nausea, constipation, confusion and respiratory depression," Dr. Christensen said. "But the most exciting part is that we're able to improve the patient's pain management by providing them with a button to elevate the dosing, so their first step when they're not comfortable is to reach for that button, rather than a narcotic." "The addition of the patient bolus button is welcomed by patients and providers," said Gregory Hickman, MD, medical director and anesthesia director at the Andrews Institute Ambulatory Surgery Center in Gulf Breeze, Fla., who has been using outpatient continuous catheters in his practice since 2007. Dr. Hickman adopted the electronic pump to give his patients the ability to bolus themselves and allow him to run a lower infusion rate. A lot of patients in his practice receive a 2 cc/hr interscalene catheter, which is enough anesthetic for most, but patients enjoy being able to boost their treatment if they need it. However, he has noticed that most patients choose not to. Leading ASCs and hospitals are ushering in a new era of opioid- sparing postoperative pain management

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