Posted on 07/20/2023 8:48:47 PM PDT by ConservativeMind
Starting a patient-controlled epidural anesthesia (PCEA) infusion while the patient is still in the operating room (OR)—rather than in the recovery room after the procedure—may help provide better pain control, suggests research.
An epidural involves placing a tiny tube called a catheter in the patient's back to deliver pain medication. An epidural may be used during surgery or after surgery, especially for those that may result in a substantial amount of pain. If it is used following a surgery, the patient can self-administer the pain medicine as needed with the push of a button.
Several issues can delay the set-up of the epidural infusion. To address these potential delays, researchers proposed a project to implement a new workflow to start epidural infusions in the OR.
"Effective pain management after surgery is a crucial issue in health care, and this streamlined approach for initiating epidural infusions in the OR reduces delays in the patient getting pain relief," said Murphy Owens, M.D.
When researchers started the project in December 2022, very few epidural infusions were started in the OR. Two months after launching the project, 90% were started in the OR. The research team surveyed 16 anesthesiologists and 13 nurses about their experience with the new workflow compared to the previous one:
56% of the anesthesiologists and 79% of the nurses said patients were more comfortable when they arrived in the PACU
56% of anesthesiologists and 79% of nurses said patients required fewer IV or oral opioids
50% of anesthesiologists and 79% of nurses said they were more satisfied with the new workflow
The project focused on streamlining the process for epidurals placed for major abdominal surgeries, chest surgeries (such as lung cancer resections), urologic surgeries and gynecological surgeries, or other surgeries where postoperative pain is expected to be substantial.
(Excerpt) Read more at medicalxpress.com ...
These were serious, pain-inducing, surgeries.
My epidural for knee ACL surgery made me paralyzed from that point in my lower back, down. It was a normal procedure but very scary. One cant help but imagine what would happen if the paralysis became prolonged. But...the doc did a super job on my knee.
It would be unusual to select an epidural for ACL unless years agon. Perhaps you had a spinal anesthetic?
Yeah....i didnt take notes at the time. Sorry. Im sure that you’re correct there doc.
A lot to unpack here but as usual the answer will be a government regulation.
—under CMS rules a block can be used for post operative pain relief providers the surgeon consults anesthesiologist for post op pain relief
—the regional or block cannot be substantially used for any part of the intraoperative anesthetic
—CMS will not pay for the postop work which has risk and workflow by using the block intraop
—loading an epidural under anesthesia after a significant amount of time has inherent risk
—one of the reasons to place an epidural and significant pain relief is achieved by blocking the initial pain. Just because a patient is generally anesthetized does not mean that the pain receptors are not engaged in surgery
—with regional the pain is blocked so there is less pain as there is not “Ramp up” pain
—combining GA with epidural especially for thoracic or abdominal surgery where the epidural is used and loaded prior to induction of GA significantly reduces the pain and anesthetic requirements and is superior for the patients.
—because CMS will not pay for this type of anesthetic care many practitioners will not incur the risk of neuraxial anesthesia
The government sucks when it interferes with medicine.
Are these your imagined rules that CMS is yet to promulgate? Because that’s not my experience, at all
That is very interesting.
Do the approval issues hold for normal insurers, too, or just the Centers for Medicare & Medicaid Services?
How likely is it that the pain receptors not being blocked could interfere with recovery, within the patient’s brain? I guess I thought, though it struck me as incompletely possible, that anesthesia could make a patient forget what just happened—meaning the brain still had a record of the actual pain experience, despite some numbing that may have occurred.
Counting on forgetting a terrible experience via chemicals has always been an uncomfortable thought, and being unconscious still doesn’t mean your brain didn’t record a bad experience.
The whole “kill the pain” part, first, really makes sense, and I can see how spinal administration could do wonders to prevent future bad dreams, if nothing else.
I do know part of anesthesia is to include numbing, but localizing numbing, rather than making it the whole body, seems less risky and, sadly, if government is interfering in how to best do that, that is disturbing.
Thank you for the insight. It sounds like people need to consider paying out of pocket, if insurance providers won’t help.
If a planned surgery, that is doable. I would hope the cost differential was not substantial, as the materials, and some of the billable time, would have been needed, regardless, just later.
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