POWER OF PUMPS While pain pumps are useful tools for controlling post-op pain, it's critical to educate patients on their safe and proper use.

The limiting factor in discharging patients hours after they've undergone painful procedures is managing their pain once they're home. That's where pain pumps come in. As more invasive procedures continue to migrate to outpatient facilities, the demand for pain pumps is only going to grow.

At the Andrews Institute Ambulatory Surgery Center, we've been sending patients home with them for 10 years and have had tremendous success. There's a learning curve for providers, but once you've mastered the skills needed to place catheters in the right locations, pumps can be a terrific alternative to the opioids-and-good-luck approach of managing post-op pain.

Elastomeric or electronic?
Which pump should you choose? There are several factors to consider. There are 2 distinct types. Elastomeric pumps slowly deflate on their own, pushing anesthetic through an IV-type tube to continuously bathe nerves with soothing relief. Electronic pumps use batteries or external power sources to provide the same relief. Elastomeric pumps, and some electronic models, are disposable and therefore typically more expensive. When patients equipped with non-disposable electronic pumps complete their treatment, they can mail the pumps back to their providers.

In either case, one of the big determining factors in which type you purchase is likely to be how much control you want your patients to have. Many providers and facilities set a certain infusion rate and literally take away the key. They won't even let nurses, let alone patients, change the rates. But if you take that approach, you limit your ability to customize care for each particular patient.

Does the pump have a bolus option? I prefer to use programmable pumps and allow patients the option to adjust infusion rates within certain parameters and also to give themselves boluses when they feel the need. In addition to helping with breakthrough pain, the bolus provides more spread in the tissue plane, so the pump can do a better job of saturating a larger area. That's really useful for any block where the catheter isn't right next to the nerve, such as an adductor canal or an infraclavicular block, where you have 3 cords of the brachial plexus bundled around the axillary artery. With elastomeric pumps, the extra push provided by the bolus may be a little slower and weaker, so it may not provide the same spread as their electronic alternatives.

"Is it working?"
Educating patients and their caregivers helps immensely. You'll be sending a patient home with a small plastic catheter coming out of their body. The more the patient knows about it and what it's doing, the better chance of limiting complications.

Electronic pumps are a little more complicated with their various dials and alarms, so they require a more detailed tutorial. On the plus side, if there's an occlusion with an electronic pump, or for some reason the anesthetic stops flowing, an alarm sounds. With an elastomeric pump, if there's a kink in the catheter, and the medicine stops flowing, there's no sure way to know.

Elastomeric pumps can also be enigmatic in the sense that it takes 24 to 36 hours for them to look as if they're getting smaller. Anxious patients sometimes call and say, "Is this thing working? It's still as big as it was when I left the surgery center yesterday." The answer tends to be: "Are you having any pain? No? Well, then it's working."

Confidence matters
Pain pumps have occasionally gotten bad raps, and it's true that they require a skill that takes significant training and experience to master, but there are a lot of good websites, courses and educational opportunities out there. With ultrasound, your success rate should be close to 100%. You greatly reduce the risk of complications when you can see that you're getting close to making an intravascular injection.

Once you become proficient, problems are extremely rare. I've placed about 10,000 in my career, and I can count on one hand the number of infections my patients have had. Plus, in all that time I've seen only one defective pump: an elastomeric pump that emptied much faster than it should have. The bottom line is that pain pumps work well and consistently. So well and so consistently, in fact, that at Andrews, we give our patients our cellphone numbers. And we know we'd get phones calls all night long if they don't work. OSM

Ambu
ACTion Fuser Pain Pump
ambuusa.com
(410) 768-6464
FYI: Disposable and latex free, the ACTion Fuser Pain Pump consists of 2 components — a compression unit and a regulator designed to maintain a uniform flow rate regardless of changes in administration pressure. The components are packaged separately, so you can fill the reservoir anywhere while maintaining the sterility of the regulator. To change a locked flow rate, you can attach a new regulator. An optional bolus lets you select and lock the bolus volume best suited for each patient.

Advanced Infusion
Alpha Infusion Pump
advancedinfusion.com
(770) 979-3379
FYI: The latex-free and DEHP-free Alpha 200 and Alpha 450 are designed to provide continuous delivery of anesthetics to between 1 and 5 surgical sites, with no dumping, and with the capability to have each catheter deliver a different predetermined infusion rate. A uniquely designed and patented elastomeric pressure chamber combines with pressure regulators to control all flow rates. The company also offers kink-resistant catheters.

Halyard Health
ON-Q
myon-q.com
(800) 448-3569
FYI: The disposable ON-Q system is completely portable and can be clipped to clothing or placed in a small carrying case. An on-demand flow controller that can also be clipped to a carrying case or clothing lets patients self-deliver a bolus, and a variable rate controller lets clinicians adjust the infusion rate. At lower infusion rates, ON-Q can deliver up to 120 hours of analgesia.

InfuSystem
InfuBLOCK
infusystem.com/block
(844) 724-6123
FYI: InfuBLOCK is an electronic pump with a separate dashboard that lets clinicians review patient pain scores, status and progress. There's a bolus option for breakthrough pain, and InfuSystem staff contact patients every day to log pain and satisfaction scores. An automatic email to clinicians is generated when pain scores exceed the clinician's pre-determined threshold. Staff are also available 24/7 to field calls from patients. Batteries are preloaded, and a pull tab activates the connection.

InfuTronix
Nimbus PainPRO
nimbuspump.com
(888) 479-8500
FYI: You can program the Nimbus PainPRO to start infusing any time within 24 hours after patients leave a facility, enabling you to take full advantage of block duration, and adding pain relief on the back end of therapy. But if the block wears off sooner than expected, patients can cancel the delay and start the infusion immediately. It features a programmable intermittent bolus to help optimize the spread of anesthetic without patient intervention, and there's also a patient-demand bolus setting. Its customizable reservoir volume can deliver up to 1000 mL, so it also lasts longer than some other pumps.

Smiths Medical
CADD-Solis VIP
CADD-Solis
smiths-medical.com
(800) 258-5361
FYI: The CADD-Solis VIP (left) offers a variety of delivery platforms, including patient-controlled anesthesia, continuous infusion, intermittent delivery, variable stepped rate and tapered infusions. To maximize block effectiveness, the infusion start can be delayed for up to 96 hours in 5-minute increments. It's powered with rechargeable batteries and has an AC adapter. Numerous alarms warn of low battery life, air in the line, occlusion and other potential issues. The CADD-Solis smart pump (right) can also be used with blocks and surgical-site infusions, and includes programmed intermittent bolus delivery to decrease opioid use.

Summit Medical Products
AmbIT Infusion System
ambitpump.com
(801) 417-0465
FYI: Designed to be a cost-effective ambulatory alternative to larger digital fluid pumps, the compact and disposable ambIT comes with 4 preset infusion rates and a fifth customizable setting. Programming is easy, says the company, and the patient-controlled bolus is user-friendly. Its volumetric accuracy (+/- 6%) rivals that of more expensive pumps, and its features include an occlusion alarm and stored infusion history reports to make charting easier.

Teleflex
Arrow AutoFuser Disposable Pain Pump
teleflex.com/autofuser
(866) 246-6990
FYI: The AutoFuser is available in 3 sizes, and has a variable rate selector, so clinicians can choose from a variety of fixed basal infusion rates. An optional patient-controlled parallel bolus lets patients immediately address breakthrough pain without interrupting continuous basal infusion. Its top-fill design includes an elastomeric balloon that's wrapped around the inside of the case, so it's easier to fill than most pumps. It's also latex-free and DEHP-free.