Pain pumps help reduce opioid use

Benefits include fewer side effects
July 6th, 2016

It’s no secret that prescription opioid painkillers have been abused and misused in Colorado and across the nation.

The recent death of the artist Prince, who accidentally overdosed on the powerful pain killer fentanyl, shined an even brighter spotlight on an epidemic sweeping America.

One of the ways hospitals reduce the amount of opioids prescribed is to use pain pumps for surgical patients – when appropriate – instead of prescribing opioids.

The ON-Q pain pump, used at Memorial Hospital, looks like a rubber ball that is inflated. The ball holds local anesthetic which runs through a tube and into a patient via a catheter that is placed at the surgical site or in close proximity to nerves.

“Anesthesiologists use ultrasound to aid them in precisely placing the catheter – it’s a little procedure before a bigger procedure and is done under light sedation,’’ said Kim Spinelli, a clinical nurse specialist at Memorial who leads a team of nurses who help patients manage pain.

The medicine in the pump generally lasts three to five days. Surgical patients having breast, lung, orthopedic or cesarean section surgeries benefit from the pumps because side effects – and the risk of opioid addiction – is reduced.

“Most people say it is an amazing device,’’ said Dr. Jack Tubbs, an OB/gyn in Colorado Springs. “I use them any time I am doing a C-section and I also use them with my minimally invasive hysterectomies. I use them routinely because it decreases the overall pain, and there is a quicker return to normal activity and recovery.

“The alternative is pain medications, typically narcotics, which tend to increase nausea, tend to increase constipation, dry mouth and, of course, with all the drive to decrease narcotic use because of all the overdoses nationally, it makes sense,’’ Tubbs said.

Dr. Laura Pomerenke, a well-known breast surgeon at the Mary Lou Beshears Breast Care Center, uses them during mastectomy and reconstructive breast surgery.

“We feel there is definite benefit and less narcotic use and, therefore, fewer gastrointestinal problems and better mobility,’’ Pomerenke said.

While pain pumps are not new in hospitals, Dr. Tom Strandness, an anesthesiologist who works in the operating room alongside Pomerenke, is part of a clinical study aimed at discovering whether a new technique for placing the pain block is safer than techniques used in the past for patients who are having mastectomy, reconstructive breast surgery, rib fractures or lung surgery.

The paravertebral block used in those surgeries is placed close to the pleura in the lungs, which poses a risk of pneumothorax, or a puncture of the lungs.

“In the study, we are looking at a way to do this block in a safer method,’’ Strandness said. “We are trying a new technique in which we make the injection a couple of centimeters away from the lung, verses millimeters away.

“We are trying to compare how patients do using the older technique verses the newer technique. And if we find that the newer technique is roughly the same, we would expand to more patients for more operations,’’ Strandness said.

Spinelli, who works with pain patients routinely and recognizes that many pain patients properly rely on opioids for pain relief, is a proponent of the pumps because patients can administer medication based on their level of pain.

“Everyone has a different pain threshold,’’ she said. “The cool thing about this is the patient controls the rate of the flow of anesthesia. Once they leave the hospital, they can adjust the medication levels.’’

Patients who have received pain pumps say they have a better overall hospital experience.

“We have a lot of data that shows patient satisfaction is higher,’’ said Roger Massengale, general manager for Acute Pain of Halyard, the maker of ON-Q.

Some studies show that patients who receive the ON-Q pain pump go home from the hospital 1.1 days sooner; report up to 69 percent lower pain scores, are three times as likely to report high patient satisfaction; and are more likely to experience better pain management with fewer side effects, Massengale said.

The lightweight pump is worn in a small pouch over the patient’s shoulder and the pump is disposable. Patients who take the pump home receive a booklet, which includes a phone number to call 24 hours a day so a patient can immediately talk to a pain management expert about the pump.

“After a patient is discharged, a nurse calls the patient and asks about their pain level,’’ Krause said. “Patients are given a lot of information at discharge and sometimes it is hard to remember. Patients really appreciate the follow-up call.

“It’s just another way to make sure patients are well cared for,’’ Massengale said.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.