how we treat acute pain really matters
DESCRIPTION
After surgery, an Acute Pain Service centered on Continuous Peripheral Nerve Blocks allows the avoidance of narcotics, hastens recovery and improves safety. Watch this brief presentation to learn more about the impact that optimized acute control can have on patient satisfaction, safety and outcomes for your hospital.TRANSCRIPT
GOALS OF CPNB PROGRAM Minimize Pain*
Not “Painless” surgery Minimize Side Effects/Morbidity Opioids
N/V, pruritis, constipation, sedation, confusion, hypoventilation
Improve Outcomes LOS*, PACU time*,ROM/Rehabilitate, Pt Satisfaction
Part of Multimodal Therapy NSAIDS, Ice, Opioids*
Pt Selection & Surgery Type influence the degree of goal attainment
YOU SHOULD FEEL GOOD ABOUT THIS!!POORLY CONTROLLED PAIN
Delayed Discharge Prolonged Recovery/Return to ADL Increased Use of Healthcare Resources Patient DissatisfactionDelays in Wound HealingDisrupted Sleep & Worsened PainMorbidity & Mortality (more than you might think!)
Chronic Pain
…and this is the BEST solution !!!
WHY SHOULD I BOTHER?
Patient Satisfaction Better experience with effective analgesia (& tell their friends) I would argue this alone is an adequate reason to pursue
Improve Safety Respiratory Depression/Airway Issues (OSA, COPD, full stomach)
Secondary Injuries (MI, CVA, blood clots, pneumonia)
Confusion/POCD* (Elderly)
Affect Outcomes Decrease Length of Hospital Stay (Faster Day Surgery & Fewer days)
Improve Early Range of Motion, Mobility & Recovery Improve Pulmonary Function Minimize Inactivity-induced Muscle and Bone Loss Decreased Persistent Pain Decreased Cancer Spread and Recurrence
WHY SHOULD I BOTHER? Decreased Length of Stay & Acuity
Hospital $$ Savings (SIX FIGURES ON RCR ALONE) Avoid or shorten ICU stays Avoid Inpatient Events (nosocomial pneumonia)
Faster Turnover Fewer ‘slow’ wake ups Less Paid Overtime I think Surgeons like this, too
Faster Outpatient Discharge Can Skip PACU completely; drops SDS time to D/C as well Shorter PACU times; less O.R. Bottle-necking Decreased Staffing Needs for Hospital/Surgery Center
Outpatient instead of Inpatient
WHY SHOULD I BOTHER?
Decreased Workload R.N.’s can perform job more effectively & more safely Less calls from PACU & Floor for ‘further’ interventions
Your Hospital’s Image Nationwide, pain control is still inadequate or poor Public more cases Administration more cases Surgeons more cases
Job Satisfaction YOU YOUR O.R. staff YOUR Hospital Staff
CPNB OUTCOMES
These improved outcomes and reduced morbidities are much more likely to manifest when used in a system-wide recovery strategy.
“Importantly, there is a critical need for collaborations between the various healthcare providers involved in perioperative patient care (e.g., anesthesiologists, surgeons, nurses, & physiotherapists) to integrate improved perioperative pain management with the recently described fast-track recovery paradigms. This type of combined approach is well documented to improve the quality of the recovery process and reduce the hospital stay and postoperative morbidity, leading to a shorter period of convalescence after surgery.
P White, H Kehlet Improving Postoperative Pain Management Anesthesiology 2010;112:1:220-5
BROADENED PATIENT SELECTIONParticular Benefit
1. OSA, especially untreated
2. Opioid-dependent?3. Opioid-sensitive4. ‘Clean’ Addict5. Elderly & Cancer pts6. Painful (2nd) Procedures7. Severe COPD/Cardiac Dz8. Risk Chronic Pain/RSD9. Full Stomach/Bad Airway10. Acute Fracture/Pain (if USG)
Particular Challenge1. Isolated – care/phone2. D.M. w/ Neuropathy (high BS & N.
Stim)
3. Evolving Neurologic Injury4. Preexisting Nerve Injury5. Anxious / Cognitive Issues6. Compartment Sd? (no cases in
literature)
7. Renal failure?/Cirrhosis/CHF8. Severe Cardiac Arrhythmia9. COPD ?10. Acute Fracture/pain (if N.Stim only)
OPEN CHOLECYSTECTOMY
This patient had an OPEN cholecystectomy less than 24 hours ago.
He is going home with a continuous peripheral nerve block (CPNB) now.
YOU SHOULD FEEL GOOD ABOUT THIS!!Patient WIN - analgesia, side-effects, home faster, better rehab & sleep, fewer complications, other
Surgeon WIN- happier patients, more patients, less rounding, less issues
Hospital WIN- patient satisfaction, length of stay, staffing cost, more pts, staff satisfaction, compliance, supply cost
Anesthesia WIN- image with admin/surgeons, satisfaction, collections, safety
Healthcare WIN - resource utilization, avoid complications, less cost
BOTTOM LINE…..ONE MORE TIME
HOW WELL WE TREAT PAIN
REALLY MATTERS!!