Success key No. 4: Pain management
In many surgeries, postoperative pain is a particular concern for patients, physicians, and hospitals. Severe pain can result in readmissions, which is undesirable for the patients and costly for healthcare facilities. To help eliminate postoperative pain, anesthesiologists are using peripheral nerve blocks that can enable patients to move quickly into physical therapy, with less need for to take narcotics and opioids, says De Ruyter of Kansas University Medical Center.
The process involves using peripheral nerve catheters to ease postoperative pain for patients following orthopedic surgery. The catheter is a threadlike tube that provides a continuous infusion of anesthesia for pain relief that lasts up to three days after procedures. Nerve-block anesthesia has been used to alleviate pain in breast cancer surgery as well as kidney stone and hernia removals.
In a study of 510 patients treated over a three-year period, De Ruyter says he found that a peripheral nerve block can provide satisfactory analgesia for several days after orthopedic procedures, particularly in outpatient settings. Of the outpatients studied, the average duration of the catheter infusion was 2.3 days, and "no patients reported falls or difficulty in removing their catheters at home," De Ruyter says. In addition, "they actually participate in physical therapy more quickly, and we have less [use of] narcotics and opioids," he notes. "There's a high degree of patient satisfaction: ‘Hey my leg doesn't hurt. This is great! Let's do it again.' And then they want the other leg [operated on]," De Ruyter explains.
While some hospitals have reported success with peripheral nerve blocks, they are less commonly used for outpatient surgical procedures because of potential catheter-related complications and patient difficulty in having access to a physician outside the hospital after being sent home.
Communication via the phone appeared to be enough to monitor the patients in De Ruyter's research. He studied patients who had undergone foot and ankle surgery between 2008 and 2009 who were offered at-home analgesic therapy. The anesthesiologist contacted each patient daily while the analgesic was in place to "assess the efficacy and safety of the block," De Ruyter says.
"The once-daily telephone contact with patients was adequate. There was minimal impact on the anesthesiology care team, and patients or caregivers were able to reliably remove their catheters at home," he says.
This article appears in the December 2012 issue of HealthLeaders magazine.