pneumothorax?" he says. "It's quick and dirty. You put a probe on the
belly or chest, you do the exam, and there are a couple of different
signs you're looking for. The accuracy is quite good."
4. "Smart" pain pumps
The better and smarter the pain pump, the more confidence patients
and providers will have in the use of continuous peripheral nerve
blocks.
"Block techniques are very valuable, because the source of the pain
is very definitive and you can pinpoint where the nerve is damaged,"
says Dr. Piracha. "If you can block that nerve signal, you've solved a
big chunk of the pain that the patient might be experiencing."
With improving technology, expect pumps to have more features
and less that can go wrong. "I do think that pumps are going to con-
tinue to evolve and become more efficient," says Dr. Piracha. "For
example, with features like intermittent blousing, if a patient can't hit
the [bolus] button because they're asleep, they may wake up in a dis-
turbing amount of pain. But pumps can be programmed to release a
small bolus, say, every 3 hours. Those kinds of built-in technologies
are bound to come about, because the technology is becoming readily
available and a lot cheaper."
5. Truncal blocks
As an alternative to epidurals, truncal regional blocks are also com-
patible with the desire to enhance throughput and minimize opioid
use. The TAP (transversus abdominis plane) block is the best-known
of the group, but several others are also increasingly being used,
including the erector spinae block and the quadratus lumborum
block. The blocks are effectuated by injecting local anesthesia into
particular muscle planes, where it spreads and reaches target nerves.
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