Catheters-To-Go Take Pain Out of Post-Operative Recovery for U Orthopaedic Center Patients

Catheters-To-Go Take Pain Out of Post-Operative Recovery for U Orthopaedic Center Patients

Apr 3, 2005 6:00 PM

Surgery patients at the University of Utah Orthopaedic Center go home with more than new knees and mended ACLs: they also take a catheter that feeds a constant supply of medication to virtually stop pain the first 48 hours after an operation.

"Orthopedic surgery no longer has to hurt so much," said Jeffrey D. Swenson, M.D., associate professor of anesthesiology at the U School of Medicine and chief of anesthesiology at the Orthopaedic Center. "The pain control with these catheters is outstanding."

To insert the catheters, anesthesiologists use a technique developed at the University that avoids actual contact with the nerve by using ultrasound. The Orthopaedic Center, which opened last fall in the Us Research Park, is the first surgery facility in Utah and one of the first in the country to provide the in-dwelling catheters following orthopedic surgery.

Every Orthopaedic Center patient who undergoes surgery for knee replacement, torn ACL (anterior cruciate ligament), or on a shoulder, ankle, or foot goes home with a catheter filled with an analgesic to block pain. More than 300 patients have received one, said Swenson, who recently had knee surgery and tested the catheter, himself.

"The difference (in pain control) was dramatic," he said.

Robert Michel, who underwent ACL construction on his left knee last week, couldnt agree more. Thirteen years ago, Michel had ACL surgery on his right knee and was given percocet and morphine for severe pain. He needed so much of both that it made him sick and Michel finally decided to bear the pain rather than endure the side effects of the medication.

Before last weeks surgery, Swenson inserted a catheter near Michels femoral nerve. The catheter was attached to a bottle containing Bupivacaine, an analgesic that deadens the nerve and controls pain. The bottle, wrapped in an elastic bandage around Michels leg, continuously dripped the medication around the femoral nerve for two days following the surgery. It worked, according to Michel.

"This is orders of magnitude better than my experience 13 years ago," he said. "Youd be crazy not to get this in the future if its offered to you."

Catheters have been used often to control pain following orthopedic surgery such as knee replacement and ACL repair. Usually, the catheter is placed right next to a major nerve and an analgesic is delivered to deaden the nerve and stop pain.

Instead of inserting the catheter right next to the nerve, with the risk of nicking it, Swenson and other U anesthesiologists developed a technique to place the catheter in a space near, but without touching, major nerves. The catheter is inserted before surgery in a three- to four-minute procedure using ultrasound to view precisely where the catheter should go and the nerve is bathed in analgesic. "We couldnt do it without the ultrasound," Swenson said. "Thats key."

Bupivacaine is contained in a balloon inside a bottle connected to the catheter. The bottle, about the size and shape of a baby bottle, rests in a sling or is wrapped in a bandage near the surgery site. The medication is released from the bottle through the catheter. When the balloon deflates, patients know the medication is gone and can remove the catheter themselves. Most people need only one, but those who still have pain can get another catheter at the Orthopaedic Center.

"Weve tried to focus on the most painful surgeries and aggressively treat them," Swenson said.

Along with the catheter, patients take something else home: Swensons pager number. Most surgery patients dont know the name of their anesthesiologist, but those at the Orthopaedic Center get 24-hour access to call Swenson day or night if they have pain problems after the operation.

As proof of how well the catheters work, Swenson said hes received only five to 10 calls out of 300-plus patients.

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