Internet remote control of pump settings for postoperative continuous peripheral nerve blocks: a feasibility study in 59 patients.
BACKGROUND
During continuous peripheral nerve blocks, infusion adjustments are essential for postoperative analgesia without side effects. Beside, physicians and nurse visits related to pump's settings and monitoring are time consuming and costly. We hypothesized that a remote control of pump's settings, by telemedicine transmission, adjusted to patients' feedbacks, is feasible and interesting in optimizing patient's postoperative pain management.


METHODS
Fifty-nine ASA physical status I and II patients were included. Ropivacaine 0.2% was infused during 72 h in CPNB catheters. After returning to the surgical ward, the patient was allowed to answer a 10 indicators questionnaire 3 times a day (8.00 AM, 2.00 PM, 8.00 PM), or unlimited on patient's demand. This information was transmitted from the pump to a server through the Internet. If one indicator was out of the predefined thresholds, the anesthesiologist in charge was immediately informed by texto on his cell phone. The anesthesiologist connected to the website, checked the data from the patient and modified the settings of the pump by remote control according to a written protocol. The changes need a secure access with a password and a confirmation. The number of settings changes, the time to realize the procedure and the adverse events related to the technique were noted. When the catheter was removed, the pump was unassigned to the patient and the data archived.


RESULTS
Thirty sciatic, 24 femoral and 5 interscalene catheters were inserted in 59 patients. Five catheters were accidentally removed before the end of the 72-h period. The median VAS pain values at rest and during movement were respectively at 2 and 3. Sixteen patients complained about numbness promoting 2 (0-3) changes in pump settings; 9 about motor blockade with 1 (0-2) change; 5 about difficulties for physiotherapy with 1 (0-3) change. The mean time of pump settings modification after response to questionnaire or voluntarily patient's alert was 15 ± 2.2 minutes. Early physiotherapy in the surgical ward was totally uneventful in 54 patients. The mean value of satisfaction scale of the patients was 8.4 ± 1.6. No adverse event necessitated a postoperative analgesia technique change.


CONCLUSIONS
Remote control pump's feedbacks and e-settings for postoperative analgesia using CPNB permitted a real adaptation to patients' needs, complaints and pain VAS values without nurse and physician physical intervention.
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates. Electronic address: p.macaire@gmail.com.
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P
Macaire
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
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M
Nadhari
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
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H
Greiss
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
A
A
Godwin
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
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O
Elhanfi
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
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S
Sainudeen
Department of Anesthesiology, Rashid Hospital, Dubai, United Arab Emirates.
M
M
Abdul
Montpellier University 1, Department of Anesthesia and Critical Care Medicine, Lapeyronie University Hospital, Inserm U 1046, bâtiment Crastes de Paulet, 34000 Montpellier, France.
X
X
Capdevila
D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009407:Nerve Block / Q000295:instrumentation* / Q000379:methods*; D019637:Orthopedic Procedures; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D019990:Perioperative Care; D010525:Peripheral Nerves; D011182:Postoperative Care; D012371:Robotics; D000077212:Ropivacaine; D011795:Surveys and Questionnaires
D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine
Blocs nerveux périphériques continus; Continuous peripheral nerve blocks; Contrôle par Internet; Pain VAS values; Remote control; Valeurs EVA de douleur