- Patient can be discharged home with a peripheral nerve catheter. The ongoing continuous administration of local anesthetic will be done with a disposable, elastomeric pump the patient will leave the hospital with.
- The elastomeric pump used at UCSF (ON-Q) provides a regular flow of regional anesthesia to specific anatomic locations to reduce pain after a surgical intervention
- The ON-Q pump is set to infuse a regular flow of the local anesthetic ropivacaine (0.2%)
- ON-Q pumps are initiated the day of discharge. They are either started after surgery in the PACU or replace the CADD pumps that have been used in the inpatient.
- Once the pump is empty and deflated, the patient can remove the catheter and dispose the complete system in the trash.
- Indications:
Ambulatory peripheral nerve infusions are exclusively used for outpatient pain management, most commonly following orthopedic surgery.
- Contraindications:
Cannot be used in patients who are not able to recognize and report adverse side effects
- Dosing:
- The 750ml elastomeric pumps are prepared and labeled by pharmacy
- Rates of continuous infusions are ordered in even increments (min: 2m/hr., max: 14ml/hr.)
- The chosen flow rate determines the duration of infusion (up to 5 days as part of a multimodal pain plan of care)
- “Select-a-Flow” rate regulators (connected to the pump) are programmed by RNs with provider order
- Neither range orders nor patient boluses are permitted
- Patients with ON-Q pumps are not permitted to alter infusion rates at home (the flow rate dial (“key”) is discarded by the nurse prior to patient discharge).
- Supplemental pain medications may be required in addition to the peripheral nerve infusion. The outpatient/discharge prescriptions are ordered by the surgical team.
- Leaking is common at the insertion site, typically managed with reinforced dressings/tape
- Local anesthetic systemic toxicity (LAST) is a life-threatening condition. The patient and home caregiver need instructions to identify the signs of LAST:
- Early signs: perioral numbness and tingling, tinnitus, metallic taste in mouth, ringing in ears, and blurred vision
- Late signs: sedation, altered mental status, seizures, coma, dyspnea, hypotension, hypertension, bradycardia, tachycardia, ventricular tachycardia, ventricular fibrillation, and asystole
- Patients/caregivers are told to clamp the tubing in the event of adverse effects
- In addition to LAST, instructions include: importance of caregiver presence, pressure sore and falls prevention, and mobility assistance
- ON-Q pumps are not intended to deliver medicine intravascularly
The American Society of Regional Anesthesia and Pain Medicine. (2018). The American Society of Regional Anesthesia and Pain Medicine Checklist for Managing Local Anesthetic Systemic Toxicity: 2017 Version. Regional Anesthesia and Pain Medicine, 43(2), 150–153. Retrieved from: https://www.asra.com/content/documents/asra_last_checklist_2018.pdf
Dave, S., Shriyan, D., & Gujjar, P. (2017). Newer drug delivery systems in anesthesia. Journal of anaesthesiology, clinic Dave, S., Shriyan, D., & Gujjar, P. (2017). Newer drug delivery systems in anesthesia. Journal of Anaesthesiology, Clinical Pharmacology, 33(2), 157–163. https://doi.org/10.4103/joacp.JOACP_63_16al pharmacology, 33(2).
Jafra, A., & Mitra, S. (2018). Pain relief after ambulatory surgery: Progress over the last decade. Saudi journal of Anaesthesia, 12(4), 618–625. https://doi.org/10.4103/sja.SJA_232_18
Kriel, H. H., & Yngve, D. (2019). Elastomeric Pain Pumps for Scoliosis Surgery. Cureus, 11(2), e4042. https://doi.org/10.7759/cureus.4042
ON-Q pump website: www.myON-Q.com. 24/7 Product Support Hotline: 1-800-444-2728