get to multiple dermatomal levels.
The manual bolus feature of an elastomeric pump is more cumber-
some, says Dr. Winchester. "It's closer to a manual flush, compared to a
digital bolus, which is slick and easier to apply. Basically, you just
press a button, like you would with a remote control. No wrist strength
or application pressure is needed." A patient-controlled bolus tends to
be sufficient with an infraclavicular or adductor canal block, he says.
4. What's the price?
Cost is another area where you'll have to think about tradeoffs.
"We had success with some of the pumps we used previously, but
the costs were escalating, and we didn't think they were worth it,"
says Dr. Canlas. "There are a bunch of products that are competitive
out there that for us do the job just fine. For us, it came down to sim-
plicity for patients as well as cost to our institution."
Dr. Winchester says he's seen the same price inflation.
"Unfortunately, some of the more established elastomeric companies
have gotten expensive. You can have confidence that they're not going
out of business in 2 weeks, and that they have a strong sales and sup-
port network, but their pumps cost a lot more," he says. "With hospi-
tals, the name of the game is to save money, and there are other
pumps coming in a lot cheaper. That's a major consideration."
So it's important to compare prices, he says. "One might be a Rolls-
Royce or a Ferrari. I'd love to drive a Ferrari, but I don't, because
they're too expensive. You might find the features of a Ferrari favor-
able, but still have to settle for a mini-van."
Prices, he says, range from around $100 to more than $400 per
pump. How you use them also affects the bottom line. In certain sce-
narios, electronic pumps are more economical, because they can be
equipped with larger bags.
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