Becker's ASC Review

69 EXECUTIVE BRIEFING 2 EXECUTIVE BRIEFING SPONSORED BY Electronic Pain Pumps Are Revolutionizing Patient Satisfaction, Safety And Outcomes For Outpatient Orthopedic Surgeries W ith many major orthopedic surgeries shifting to the outpatient setting, ASCs and hospital outpatient departments are grappling with how to help patients heal at home and achieve high levels of patient satisfaction while limiting opioid use. Anesthesia providers can achieve this with new postop pain management solutions like regional anesthesia and new pain pump technologies that safely extend the duration of pain relief for orthopedic surgery patients out to five days. Becker's Healthcare recently spoke with two anesthesiologists about the benefits of innovative pain pump solutions compared to legacy elastomeric pain pumps: • Leslie Thomas, MD, director, regional anesthesia and acute pain, Ochsner Health in New Orleans • Scott E. Thomas, MD, regional anesthesia fellowship director, Andrews Institute ASC in Gulf Breeze, Fla. The following article is based on those conversations and additional statements made by Dr. Leslie Thomas during a March webinar. Regional anesthesia enables ASCs to perform major orthopedic surgeries on an outpatient basis Having a pain management strategy for orthopedic surgery patients, especially those undergoing total joint replacements, is critically important. "Patients that have a positive perioperative experience can be an incredibly powerful tool in recruiting new business by word-of-mouth marketing," Dr. Scott Thomas said. Continuous catheters not only improve patient satisfaction, but they also improve surgical outcomes. Rehab and therapy are huge components of successful surgeries and the whole perioperative process. According to Dr. Scott Thomas, "When patients aren't limited by pain, they can work harder in rehab postoperatively. That helps prevent formation of scar tissue and other complications. On total knee cases, when patients have good therapy sessions for the first few days after surgery, that sets their recovery course and gets them moving in the right direction." Unlike opioids, the medications used with nerve catheters for regional anesthesia don't alter the patient's balance, motor function or ability to stand on crutches after surgery. "Our patients need to start PT about an hour after they get out of the operating room," Dr. Leslie Thomas said. "With multimodal analgesia, a peripheral nerve catheter and therapy, patients can safely go home after their surgeries." Dr. Scott Thomas emphasized that "in the modern era of social media and online reviews, patient satisfaction can be paramount to the success of an ASC." "A single positive patient experience can be worth its weight in gold for attracting not only new patient business, but new surgeons too," he said. "No marketing technique is more powerful, or more cost-efficient, than a personal recommendation from a trusted friend or family member." Electronic postop pain pumps ensure patient safety and satisfaction during the in-home healing process Next-generation, electronic postop pain pumps are much more configurable, more precise and more reliable than legacy elastomeric pumps. "If we are doing a shoulder surgery versus a knee surgery, we can use different pain pump infusion settings," Dr. Scott Thomas said. "This ensures the best outcome for the patient, while minimizing the total amount of medication they receive and reducing potential drug side effects. We can also track how much medication the patient has received. This is a huge advantage compared to elastomeric pumps." Dr. Leslie Thomas agreed: "When we used elastomeric pumps, we would call patients and sometimes the drug reservoir would be empty after 24 hours. I don't feel comfortable sending people home with those anymore, due to concerns about local anesthetic toxicity. Surgeons also saw more neuropathic pain in some patients, especially total knees. We thought it could be because patients were getting so much local anesthetic on specific nerves in such a short period of time. Since we started using electronic pumps, we haven't seen that." Intermittent Bolus infusion mode uses less medication, enhances anesthetic spread and provides five days pain relief Electronic pain pumps support a new infusion mode called intermittent bolus which has several benefits. With continuous infusion, the anesthetic may not achieve the spread needed within the nerve space. When anesthesia providers program an electronic pain pump to infuse an automated bolus every few hours, that forceful delivery gives the spread required to manage pain without draining the anesthetic reservoir too rapidly. "One of the most common reasons a patient seeks unplanned care after surgery is due to poorly managed pain," Dr. Scott Thomas said. "A well-placed catheter and a smart pain pump

• Cover