gesic, doesn't suppress breathing like an opioid would. Cost is an
issue, however. "About two years ago it would be very difficult to
get it approved," he says. "They would only approve it for very spe-
cific cases. But now it's used a lot more."
• Regional anesthesia/nerve blocks. These injections, which
deposit numbing or weakening medication, vary in length depend-
ing on the type of local anesthetic used. "You have perineural,
when we get close to the nerve; incisional, which is often done by
the surgeon, or intra-articular, where the surgeon can inject into
the joint," says Dr. Schechter. Provided as a single shot or contin-
uously via pain pumps, they can provide long-lasting pain relief.
• Take-home pain pumps. Available in electronic and elas-
tomeric versions and used with a catheter, these range from
devices that provide a steady-state drip of local anesthetic to
more advanced, expensive devices that can provide demand dose,
enabling patients to self-deploy extra analgesic. "This is a definite-
ly a good tool to use," says Dr. Schechter, who adds that educat-
ing patients on proper use, and informing them to recognize side
effects and complications, are vital to success and compliance.
He suggests daily follow-ups to check in on these patients at
home. "Usually after two days, over the phone, the patient pulls
the catheter," he says, adding that the pumps work very well and
problems are rare.
• Neural modulation. Peripheral nerve stimulators are devices
that can be placed with ultrasound, like other blocks, but can sit
close to a nerve for two months or so. Dr. Schechter says proof-of-
concept studies show potential for use in outpatient procedures
like rotator cuff repair, and foot or knee surgeries. However, he
says, they're expensive, so you need to justify their cost. "This is
electrical stimulation that's applied before surgery, typically in the
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