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son the anesthetic stops flowing, an alarm sounds. With an elastomer-
ic pump, if there's a kink in the catheter, and the medicine stops flow-
ing, there's no sure way to know.
Elastomeric pumps can also be enigmatic in the sense that it takes
24 to 36 hours for them to look as if they're getting smaller. Anxious
patients sometimes call and say, "Is this thing working? It's still as big
as it was when I left the surgery center yesterday." The answer tends
to be: "Are you having any pain? No? Well, then it's working."
Confidence matters
Pain pumps have occasionally gotten bad raps, and it's true that they
require a skill that takes significant training and experience to master,
but there are a lot of good websites, courses and educational opportu-
nities out there. With ultrasound, your success rate should be close to
100%. You greatly reduce the risk of complications when you can see
that you're getting close to making an intravascular injection.
Once you become proficient, problems are extremely rare. I've
placed about 10,000 in my career, and I can count on one hand the
number of infections my patients have had. Plus, in all that time I've
seen only one defective pump: an elastomeric pump that emptied
much faster than it should have. The bottom line is that pain pumps
work well and consistently. So well and so consistently, in fact, that at
Andrews, we give our patients our cellphone numbers. And we know
we'd get phones calls all night long if they don't work.
OSM
Dr. Hickman (ghickman@andrewsinstitutesc.com) is the
medical director and anesthesia director at the Andrews Institute ASC in Gulf
Breeze, Fla., and a co-founder of blockjocks.com.
Thinking of Buying …
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