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.

2. GOALS OF CPNB PROGRAM

Minimize Pain*


Minimize Side Effects/Morbidity Opioids


N/V, pruritis, constipation, sedation, confusion, hypoventilation
Improve Outcomes


Not “Painless” surgery
LOS*, PACU time*,ROM/Rehabilitate, Pt Satisfaction
Part of Multimodal Therapy

NSAIDS, Ice, Opioids*
Pt Selection & Surgery Type
influence the degree of goal attainment

3. YOU SHOULD FEEL GOOD ABOUT THIS!!
POORLY CONTROLLED PAIN 
Delayed Discharge
Prolonged Recovery/Return to ADL
Increased Use of Healthcare Resources
Patient Dissatisfaction
Delays in Wound Healing
Disrupted Sleep & Worsened Pain
Morbidity & Mortality (more than you might think!)
Chronic Pain
…and this is the BEST solution !!!

4. 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


5. 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

6. 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


7. 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

8. BROADENED PATIENT SELECTION
Particular Benefit
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
OSA, especially untreated
Opioid-dependent?
Opioid-sensitive
„Clean‟ Addict
Elderly & Cancer pts
Painful (2nd) Procedures
Severe COPD/Cardiac Dz
Risk Chronic Pain/RSD
Full Stomach/Bad Airway
Acute Fracture/Pain (if USG)
Particular Challenge
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Isolated – care/phone
D.M. w/ Neuropathy (high BS & N. Stim)
Evolving Neurologic Injury
Preexisting Nerve Injury
Anxious / Cognitive Issues
Compartment Sd? (no cases in literature)
Renal failure?/Cirrhosis/CHF
Severe Cardiac Arrhythmia
COPD ?
Acute Fracture/pain (if N.Stim only)

9. 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.

10. 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

11. BOTTOM LINE…..ONE MORE TIME
HOW WELL WE TREAT PAIN
REALLY MATTERS!!