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Extended Post-Op Pain Control
Continuous nerve blocks and long-acting anesthetics provide patients with long-lasting relief.
Gary Schwartz
Publish Date: March 9, 2021   |  Tags:   Pain Management
GUIDED IMAGERY Anesthesia providers use ultrasound guidance to place catheters in a targeted group of nerves for improved post-op pain relief.   |   Pamela Bevelhymer

Patients who are discharged hours after procedures that used to require inpatient stays to recover don't hurt any less. Today's pain control methods must advance along with surgical techniques in order to send patients home safely and comfortably after outpatient procedures that are increasing in complexity. If you want to extend the effects of analgesics for two to four days post-op — a critical timeframe in which pain is often at its worst — there are two main ways to do it:

  • Single-shot injections. Bupivacaine liposome, a long-acting anesthetic, is approved for local infiltration or for use with fascial plane blocks and interscalene nerve blocks. This single shot, administered around the surgical site, is used mostly for shoulder arthroscopies, rotator cuff repairs, as well as total hips and total knees. The non-opioid local anesthetic is usually given intraoperatively and can provide patients with days of pain relief upon discharge. After the drug wears off, patients transition to a traditional mix of oral analgesics as needed.

The risk of infection is lower than with catheter placements involved in continuous nerve blocks, and the single shots are easier for providers to administer. They're also easier to manage post-discharge because there is less of a need for providers to be available to communicate with patients in the days immediately after surgery.

Continuous nerve blocks. Peripheral nerve catheters and pain pumps are good choices for busy outpatient facilities, robust orthopedic practices or centers with affiliations with large hospital programs. These high-volume operations are best suited to administer continuous nerve blocks because of the expertise needed in placing the catheters, as well as the 24/7 on-call support required for patients in the days after their procedures. A facility that uses these pumps once a month isn't going to be successful, for many reasons: It needs the purchasing power of buying the pumps in bulk to make the devices affordable; a provider has to fill the pumps if pre-filled options aren't purchased; and the technical skill of an anesthesia provider is needed to properly place the catheter.

Patient and procedure selection are critical when deciding to employ pain pumps. The devices are ideal for procedures that have an expected recovery of more than two to three days. Examples: orthopedic procedures involving aggressive manipulation or repeated manipulations during the first few days post-op, or recoveries requiring patients to return for intensive physical rehabilitation the day after surgery.

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