bolus options, and aren't as precise. "They might run higher than they
need to and run out quicker," he says.
Still, he says, "all things considered, I think for a pump being used for
a wide variety of patients in an ambulatory setting, with a wide range
of intellectual capabilities and medical understanding, simple tends to
be better."
Dr. Canlas agrees. "Ergonomics and simplicity of use are the biggest
factors as to why we chose one pump over another," he says. "The
simpler the pump, the fewer potential malfunctions and the less con-
fusing to patients. The fancier pumps may allow you to do some other
things, but it really depends on your patient population. We don't want
to overcomplicate things for our patients."
4. Do you need a bolus?
As noted, the most-basic models provide a steady flow of anesthetic,
and nothing else — not even a bolus. But the experts we talked to
strongly favor having a bolus option, at least in the vast majority of
cases.
"It gives patients a little bit of control," says Steven Butz, MD, an anes-
thesiologist at the Children's Hospital of Wisconsin Surgicenter in
Milwaukee. "It also gives me an idea of how the pain control is by
telling me how often patients are hitting the button, when I follow up
with post-op phone calls. It tells me how well the pump is working and
whether I need to go up or down on the rate."
Dr. Canlas initially worried that giving patients a bolus option could
lead to episodes of local anesthetic toxicity, but says his facility
recently decided to allow patients more control. "Some patients may
actually get better relief with a lower basal rate with a higher bolus
rate that has lockout capabilities," he says. "I've seen success both
ways."
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