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to use," he explains. "Patients should have a complete understanding of how the
pump is functioning, especially when they're administering demand doses."
It's tough on providers to determine how effectively they're able to control
pain in patients who are discharged hours after surgery, before the analgesic
effects of the initial block wear off. "If we had more information about how a
pump works, especially if it were delivered to us remotely, that would be hugely
helpful in improving our pain control practices," says Dr. Ivie.
Dr. Elkassabany believes smart pumps are especially effective in extending
the effects of myofascial blocks, which work great after administration of the
initial bolus of local. "But once the catheter is placed and the infusion slows to a
series of drips, the block's effectiveness wanes," explains Dr. Elkassabany. He
says being able to program pumps to automatically deliver boluses at set times
— 10 ml for 3 minutes every hour, for example — is a novel way to use smart
pumps to extend a block's effectiveness.
There's also a movement to use smart pumps to capture data of a pump's infu-
sion history and how often patients activate demand dose boluses in order to
quantify pain or determine the best methods for using the pumps to control post-
op discomfort.
Dr. Elkassabany says some pumps capture patient-generated feedback on a
USB port, which patients use to download the information to a centralized web-
site. Physicians can then access the data and use it to enhance their pain control
practices. "The information is power," says Dr. Elkassabany. "It provides a clini-
cal dashboard, which informs us about why catheters were placed, which physi-
cians placed them and how effectively they managed patients' pain."
Added value
Dr. Ivie uses analogue elastomeric pumps, which run between $200 and $300.
"Expense is the only reason we're still using that modality," he says. If cost was-
n't an issue — the price of smarter pumps is starting to move toward those of
elastomeric models — he'd love to use a more advanced model with demand
