Managing Pain at Home
BACKGROUND: Using small pain catheters, which are inserted along side peripheral nerves, patients can now have relatively major surgery performed on an outpatient bases with minimal postoperative pain. The tiny catheters can be use for pain treatment after most shoulder replacements and hip, knee and elbow surgeries.
Right before surgery, patients have a small catheter inserted under the skin that feed the nerves that will be impacted during and after surgery. The catheter is connected to a pump holding a safe amount of novocaine. After surgery, patients use a dial to increase or decrease the amount of novocaine reaching the nerves, depending on the amount of pain medication needed. Patients can go home a few hours after surgery, and wear the pain pump for about three days. "They can dial back the local anesthetic," Randall Malchow, M.D., Director of the Regional Anesthesia and Acute Pain Fellowship at Vanderbilt University Medical Center in Nashville, Tenn., told Ivanhoe. "If they're not numb enough, they can go ahead and increase the rate on the pump, so it infuses a continuous novocaine -- a long-acting Novocain -- through the pain catheter."
Patients pull the catheter out themselves and continue pain medications. Doctors say the home pain management system drastically reduces costs, because patients don't need to spend days in a hospital bed. It also reduces the need for narcotics. "Narcotics are effective for pain, but there's a lot of baggage associated with them from nausea and vomiting to constipation and decreased sleep," said Dr. Malchow. "We've also identified an issue that narcotics actually make you more sensitive to pain and lower your pain threshold, so while they're effective in the short term, they hurt you tomorrow and the next day and a month later. We have to minimize narcotics and use other modalities."
RISKS: Doctors say the biggest risk associated with the home pain catheter is that if it doesn't work, the patient has to be admitted to the hospital and doctors and nurses have to administer the pain meds. There is also a 1 percent risk of infection. Doctors say the pump holds exactly the right amount of novocaine to prevent overdose. The home pain catheter can be used for shoulder, elbow, wrist, knee and hip replacements. "It may be $2,000 a day to have a patient stay in the hospital, so in this era of trying to reduce health care costs, if we can reduce their hospitalization from three days to one day -- or even better, to discharge them on the day of surgery as an outpatient -- we've dramatically changed the cost of that shoulder replacement or other major surgery," said Dr. Malchow.