blocks can be extended for an additional 48 to 72 hours. Many dispos-
able elastomeric pumps are commercially available, and easy and safe
to use in both ambulatory and inpatient settings.
Establishing an ambulatory peripheral nerve catheter service may
sound daunting, but it may actually be easier than you think. Patient
selection is the key. You need to ensure that the patient understands
English and has a working phone at home. Provide both oral and
written instructions to the patient and care-taker before discharge, as
well as a 24-hour contact number they can use if they have questions.
Explain how to use the pump, what to expect when the primary
block resolves, the importance of limb protection, how to treat
breakthrough pain and how to handle catheter-site leakage. Also, dis-
cuss a catheter-removal plan and be sure patients with lower extrem-
ity blocks understand the risk of falls. Make sure an anesthesiologist
contacts the patient daily while the catheter is still in use. Numerous
studies have shown that under the right circumstances, continuous
peripheral catheters are very safe and effective for outpatients, with
high reported patient-satisfaction scores.
Attack pain on all fronts
Although pain after surgery is a challenge, we have numerous effec-
tive therapies in our arsenal. Again, the keys are to start treating pain
with preemptive analgesia early and to not reach for opioids first.
Using a multimodal approach focused on non-opioids will provide
better pain control, decreased unwanted side effects and better out-
comes. OSM
1 1 1
J U N E 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Dr. Baratta (jaime.baratta@gmail.com) is a clinical assistant professor of anesthesiology and director
of regional anesthesia at Sidney Kimmel Medical College at Thomas Jefferson University in
Philadelphia, Pa.
