1. Continuous Infusion Pumps For Post-Operative Pain Control Oksana Sidorevich, RN State University of New York Institute of Technology
Abstract
A large number of patients who undergo knee surgery experience moderate to severe pain post-operatively. This pain interferes with recovery time, and in some cases delays recovery. Studies show that approximately 10% of all surgical patients will develop a persistent postsurgical pain condition. Postoperative pain has a negative effect on quality of life and functioning; therefore pain management is an important factor to prevent complications and adverse outcomes (Lindberg, 2013). Spinal anesthesia provides the best circumstances for ensuring that patients’ initial analgesia requirements are met. Continuous infusion pumps have been introduced to improve postoperative pain. These pumps have showed better pain relief and less need for opioids. Pumps are typically filled with an anesthetic medication-ropivacaine, an NSAID-ketorolac, and epinephrine. Studies should also be conducted into the potential use of local infiltration analgesia (LIA).
Introduction
Problem
Evidence
Recommendation
PCA’s cause sedation, confusion, delirium, constipation, nausea and vomiting.
Continuous infusion pumps deliver pain relief without sedation or other adverse effects associated with opioids .
Pumps are usually filled with an anesthesia agent (ropivacaine), NSAID (ketorolac), and epinephrine.
Local infiltration analgesia (LIA) is a systematic infiltration of ropivacaine, ketorolac, and adrenaline into the tissues surrounding the surgical site to treat pain. Ability for bolus doses is available.
Patients with continuous pumps and the LIA either did not require morphine or only required 1-2 doses post operatively.
Oral medications should also be used, such as Celebrex, oxycodone extended or immediate release, and if clinically possible other NSAIDS.
Infusion pumps are usually discontinued after 48hrs, they can stay in for up to 5 days.
Facility should conduct own studies to test the effectiveness of continuous infusion pumps.
Trials of LIA should also be done by the facility.
Education for surgeons into the different types of infusion pumps available.
Patients should be presented with option of usage of continuous infusion pumps.
34-84% of all patients experience moderate to severe postoperative pain after orthopedic surgery.
Early mobilization is required to promote rehabilitation, and decrease risk of complication.
Oral opioid medication is not enough to control patients pain.
Pain management after total knee arthroplasty remains a great challenge. The immediate postoperative period is the most critical aspect to allow speedier rehabilitation and reduce the risk of postoperative complications. Failure to provide adequate analgesia impedes aggressive physical therapy, which is critical to maintaining range of motion. It potentially delays hospital discharge as well as increases risk of thromboembolism. The goal for healthcare staff is to provide adequate analgesia to facilitate early ambulation, which leads to fewer complications, and early onset of rehabilitation.
“In adult orthopedic patients how does the use of continuous infusion pumps compared to only oral medication affect post-operative pain.”
PICO Statement:
Conclusion
Continuous infusion pumps have been shown to decrease pain after knee replacement surgery. Early mobilization became a possibility, fewer doses of opioids are required with these pumps. Facilities and orthopedic surgeons need to be aware of this data to provide the most effective care for our patients; to minimize adverse outcomes after surgery

2. References
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