Post-operative nausea and vomiting gets most of the press, but post-op pain is no picnic either for you and your patients. Recent surveys report only modest success in providing suitable analgesia, as 30 percent to 86 percent of surgical patients report moderate to severe pain after a surgical procedure, according to separate studies.

If you believe that controlling patients' post-op pain is the great barrier to converting inpatient procedures to ambulatory procedures, then you'll be interested in the results of a recent survey from the American Society of PeriAnesthesia Nurses. It found that intravenous pain pumps are good at controlling patients' post-op symptoms, but they can be a real pain for nurses and patients alike.

• Interestingly, 63 percent of nurses and 56 percent of patients agree that lack of mobility due to the IV pole, equipment and line into the patient's arm is its chief drawback, especially since early mobility after surgery is an important factor in recovery for many patients.
• Additionally, 46 percent of patients see "discomfort with having a needle put in your arm" and the fact that IV patient controlled analgesia "requires a needle" as major drawbacks.

So although such advanced analgesic techniques as epidural analgesia or perineural catheters can provide superior analgesia, they're labor-intensive and expensive. What's more, intravenous patient-controlled analgesia pumps can hinder patients' care, recovery time and comfort.

A promising modality that might help improve post-op analgesia is the portable pain pump. In a relatively simple technique, the surgeon places a catheter to infuse local anesthetic into wounds at the end of the procedure. Portable pain pumps

• can be widely used;
• are technically efficient;
• offer the potential to provide complete analgesia or to substantially reduce the need for opioids and their related side effects;
• can be used for several days;
• can be used on an ambulatory basis;
• reduce facility stay by several hours; and
• result in less PONV (you knew puking would nudge its way in) than narcotics-based IV patient-controlled analgesia.

As the concept of sending otherwise healthy patients home just a few hours after surgery continues to take root, consider the pivotal role pain control plays in this phenomenon.

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We're pleased to announce the debut of our Continuing Education program. Please see "The Essentials of Competency Programs for Ambulatory Surgery and Hospital Outpatient Settings" on page 80.