6 2
O U T P AT I E N T S U R G E R Y M A G A Z I N E O N L I N E | D E C E M B E R 2 0 1 4
bring their pain to a manageable 4 or 5 out of 10. Add that taking oral
pain medicines will further reduce their pain scores to 2 or 3. Tell
patients that the pain catheter is not to treat all their pain, but is mere-
ly an adjunct. Remind them that the problem with the catheter is not in
taking it out — it slides right out when you remove the plastic bandag-
es that lie over top of it — but in keeping it in. Tell them to take care
not to let the catheter get caught on something. Also warn patients
about the unwanted side effects of pain catheters: droopy eye, fullness
in the throat or difficulty sensing that you're breathing when used for
shoulder surgery, for example.
5. Tools to shorten the learning curve. Pain
catheters have become more common because ultrasound technology
has improved and become more affordable. Before ultrasound, it was-
n't easy to place catheters. You need to visualize the nerves and blood
vessels in order to place effective and safe blocks. The key is to see
the needle at all times with the ultrasound. If you can see the needle
and the structures, you can be confident that you're avoiding the
structures you want to avoid.
When you hook the catheters up in the recovery room to the pain
pump that the patient will go home with, fill the pain pump or ball
with a much lower concentration than the local anesthetic. The
patient might receive 0.5% ropivicaine for the procedure and 0.2%
ropivicaine from the pain pump. This allows for some feeling and sen-
sation to return to the blocked limb. The goal is not to have the limb
so numb that the patient can't feel anything. OSM
Dr. Kasper (
vincent.k asper@g ma il.com
) is an anesthesiologist with United
Anesthesia Services. He is the chief of anesthesia at the Rothman Orthopaedic
Specialty Hospital and the Jefferson Surgery Center at the Navy Yard, both in
Philadelphia, Pa.
P O S T - O P P A I N
