Feasibility of infusion pumps for continuous spinal administration of local anesthetics in post-operative pain therapy.
OBJECTIVE
For completion of perioperative care and for general ethical considerations, any intraoperatively used catheter technique should be utilizable for post-operative pain therapy. Continuous spinal anesthesia (CSA) is an established form of local anesthetic application. However, for its use in post-operative therapy, infusion pumps are required that are technically able to deliver low rates and are distinctive in design to avoid possible pump or medication swaps. Because of a lack of devices specifically designed for CSA, we investigated the potential deployability of infusion pumps for post-operative pain therapy via CSA microcatheters, which were originally designed and approved for different applications.


METHODS
The accuracy of infusion rates of three different pumps was measured in a liquor model environment. Furthermore, we investigated safety and user-friendliness by interviewing 30 anesthesiologists and 15 pain nurses.


RESULTS
Except for the first hour of infusion, all pumps provided comparable and adequate flow profiles. However, interviews revealed significant risk factors for all pumps in terms of swapping devices, lines or medications and misprogramming the units.


CONCLUSIONS
All pumps tested were technically able to deliver accurate flow rates; however, because the non-CSA-specific design involves the risk of medication overdosage and syringe swaps, none of the systems tested can be recommended for routine use in post-operative CSA, irrespective of the fact that it was an off-label application anyway. Therefore, to ensure patient safety, continuous spinal administration of local anesthetics via microcatheters is a questionable method of post-operative pain therapy as long as non-specific pumps are used.
Department of Anesthesiology and Intensive Care, University Hospital Münster, Münster, Germany. manuelwenk@uni-muenster.de
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D000208:Acute Disease; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D003627:Data Interpretation, Statistical; D006801:Humans; D007260:Infusion Pumps / Q000009:adverse effects; D009726:Nurses; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D010820:Physicians; D012307:Risk Factors; D012449:Safety
D000779:Anesthetics, Local