Pump Up Your Pain Management

Anesthesia

By: John Dombrowski

Published: 10/10/2007

Share:

Pain pumps are the new frontier of outpatient surgery. Here's a rundown of the latest products on the market, and why you need them.


Here's a review, alphabetically by company, of the leading pain pumps on the market and what you need to know before deciding which to buy (also see "Which Pain Pump is Right For You?").

  • Alpha Pumps (200ml or 450ml) by Advanced Fusion. The Alpha Pumps allow for continuous anesthetic block administration after surgery, making this pump ideal for pain control after orthopedic cases. I like this pump because there are no moving parts that can malfunction and the pump can be refilled as necessary using a syringe and sterile technique. A pressure regulator maintains a constant 6 psi pressure in the outflow chamber for continuous and uniform flow of medication. That means it's a set-and-go pump, and therefore easy to use. The only drawback I see is that the large capacity of the 450ml model might make it a relatively big item for a patient to carry around.
  • Medley PCA by Alaris Medical. This pump is intended for the anesthesia provider to use during surgery. He can administer different medications through a syringe, and dial in the flow rate and medication name. The pump lets the anesthesia provider measure constant flow rates for particular drugs throughout a case. The pump is integrated and modular, so it works well with other pieces of equipment in the OR.

In addition, the pump can be hooked up to a pulse oximeter to measure levels of sedation; the anesthesia provider is therefore able to trend the pulse to the amount of sedation given. This pump would work well in an endoscopy suite. Currently, Alaris is offering a pump module, a syringe module and two pulse oximetry modules.

  • Syndeo PCA by Baxter. An infusion device allowing for IV epidural, intravenous and subcutaneous deliveries of pain medication. The good thing about this pump is that it can be used in several different modalities, therefore eliminating the need to buy several pumps for a varying case mix. This is a highly programmable device, but the interface is user-friendly and therapy-specific, a design component that is hugely valuable in such a versatile pump.

Like other programmable pumps, the Syndeo PCA tracks infusion history, letting staff monitor patient compliance with therapy directives, and therefore the effectiveness of your pain control protocol.

  • Paincare 3200 and 4200 by Breg, Inc. Like the Alpha Pumps, this product is perfectly suited for use as an outpatient post-op pain control device. The 4200 administers pain medication for approximately four days at the rate of 2ccs per hour; the 3200 provides approximately 50 hours of pain relief with a 4cc-per-hour drip.

Which Pain Pump is Right For You?

Here are four factors to consider when selecting the right pump for you.

•  Reimbursement. Check with your third-party payers to see if they'll cover the pump you're considering.

•  Functionality over form. When researching the various models on the market today, you'll note that some brands are more complicated than others, with access codes to memorize or lots of different screens to toggle through. Don't get swept away by the technology of a pump. Ease of use is an important consideration, and sometimes simpler is better.

•  Safety. While not all bells and whistles are needed, a pump's safety features are important extras to shop for. Having the ability to program patient-controlled bolus lockouts is key. This feature prevents excess medication from being administered in the event of a pump that jams or a patient who loses track of bolus allotments. For example, a pre-set dose of 1mg morphine with an interval of 10 minutes and a lockout of 6 mg/hour will let a patient deliver a maximal additional amount of morphine equal to 6 mg/hour above whatever basal dose is being delivered.

•  Capacity. You also have to keep in mind the capacity of the pump's medication bladder. A bladder's capacity varies, and depending on the surgery, greater access to medication is easier on patients. Larger bladders means patients don't have to wait for a home healthcare nurse or a trip to the surgeon's office for additional medication or an adjustment to dose levels.

Because your patients generally don't go home with IVs or spinal/epidural catheters still in place, the typical pain pump is the one the surgeon orders and the PACU staff fits to a catheter the surgeon has installed into the site of surgery. These types of pumps generally don't have a PCA component and simply deliver a pre-set amount of local anesthetic (for example, bupivacaine, which has a duration of action of about six hours).

- Adam Dorin, MD, MBA

Dr. Dorin (writeMail("[email protected]")) is the medical director of the SHARP Grossmont Plaza Surgery Center, and a member-shareholder of the Anesthesia Services Medical Group in San Diego.

The thing I like about this pump is that an optional 4cc bolus bulb is included so patients can self-administer an extra dose of medication when needed. Another nice feature: The pump has a window so staff can see if the medication is in fact being infused. Since it has no moving parts, and therefore doesn't make a sound when in use, it's impossible to tell if the pump is working without the window. Patients sent home with the pump are also able to see the pump working, potentially eliminating the need for a call or trip back to your facility if questions arise about whether medication is actually being administered.

  • On-Q PainBuster Post-op Pain Relief System by I-Flow. This system provides continuous infusion of a local anesthetic directly into the patient's surgical site for up to five days, making this device ideal for pain relief after breast augmentation surgery or ACL repairs. The system's versatile catheter design (available in 2.5-inch and 5-inch lengths) lets it infuse local anesthetic over a wider area than point-source catheters. I believe this pump's low profile would make it easy for patients to carry when they leave your facility, but they are unable to bolus themselves if they find they need extra pain medication.
  • Accufuser 275 by McKinley Medical. Similar in function to the I-Flow pump, the Accufuser allows for infiltration of the wound area at multiple sites. Unlike the I-Flow, however, patients have the ability to get additional pain medication by hitting a button. The wide range of flow rates and bolus volumes feature controlled lockout intervals, and orthopedic and wound-site regional anesthesia applications are available. This is a simple and easy-to-use product, in my opinion, without a noticeable downside.
  • PainFree Pump by Sgarlato Labs. A spring-loaded delivery system makes this pump's medication administration more precise. Most pumps utilize a balloon system to infuse medication; when medication is added, the pump's balloon is stretched and its loss of elasticity results in a dose variation of 10 percent to 15 percent. With a flow rate of one day to four days, the PainFree Pump can be used in a variety of applications, including orthopedic, general and plastic surgery, and hernia-repair cases.
  • AmbIT PCA by Sorenson Medical. Sorenson Medical was able to capture the features and technology found in its inpatient PCA to make a very sophisticated portable and disposable pump suited for ambulatory surgery. Continuous and PCA doses are managed by a programmable computer chip, meaning the pump is run by battery, so this isn't a simple set-and-go device.

The Case for Pain Pumps

Inguinal hernia repairs and pain pumps go together like diaper changes and nose plugs. If you're performing one, you should have the other. So why aren't pain pumps used universally in outpatient settings?

Like any relatively new concept in healthcare, administrators and staff are hesitant to accept the unfamiliar. The fact that these pumps go home with patients without the supervision of clinical staff also causes a certain amount of anxiety. Getting over that anxiety is a simple matter of educating yourself and your staff on both the workings and benefits of pain pumps. Conventions are a great place to learn about the technology and so are local workshops sponsored by pump manufacturers.

Still not convinced? Well, consider that nausea and inadequate pain control are the two main reasons post-op patients are admitted to hospitals for overnight stays. Using regional anesthesia instead of a narcotic during surgery helps to potentially eliminate post-op nausea. Post-op pain is a different story. Without the soothing effects of narcotics, convalescing patients need alternative means of pain control. Pain pumps will access nerves to keep the surgical area numb and will reduce patients' pain, therefore letting them leave your facility sooner.

- John F. Dombrowski, MD, PC

Patient-controlled bolus volumes can be set as high as 20ml (in 0.1ml increments) with lockout times from five minutes to 12 hours. But that technology also means this is an extremely accurate pump, even more precise in its medication administration than spring-loaded models. This pump also tracks the number of patient-controlled boluses that are dispensed. That's a nice feature that you can use to help comply with JCAHO's desire for facilities to track patient pain levels.

The pump's precision is suited for complex orthopedic or general surgery cases, but the bells and whistles might make the product cost-prohibitive for more basic outpatient cases.

  • Pain Pump 2 by Stryker. This is a disposable pump with programmable settings that allows for patient interaction and active pain management, but with a lockout feature that prevents patients from changing the settings you program. The feature I like best is the alarm that sounds if the tube between the pump and the patient develops an occlusion. A kink in the tubing is sometimes difficult to notice, and pain medication can't be administered when it does happen. Like the AmbIT PCA, this pump is very sophisticated and is suited for more serious orthopedic and general surgery cases.

Related Articles