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Enhancing Postoperative Pain Management and Decreasing Hospital Length of Stay on a Pediatric Orthopedic Unit: Implementation of an Ambulatory Continuous Peripheral Nerve Block Program



      Pediatric Ambulatory Continuous Peripheral Nerve Block (ACPNB) programs are a safe and effective pain management modality that can reduce patient length of stay (LOS) while ensuring optimal, multimodal pain management at home after surgery. Our institution previously solely used electronic infusion pumps to deliver local anesthetic via peripheral nerve catheters, requiring postoperative inpatient admissions for pain management. We aimed to enhance postoperative pain management and decrease hospital LOS after orthopedic foot and ankle surgery through implementation of an ACPNB program.


      An ACPNB program was developed and implemented for pediatric patients undergoing foot and ankle reconstruction surgery.


      We provide a detailed description of the multidepartment collaboration led by the acute pain service (APS) and orthopedics that resulted in the development and implementation of a pediatric ACPNB program using portable, elastomeric devices for patients undergoing reconstructive foot and ankle surgery. Implementation tools, including caregiver and nursing education resources, a data collection log, a process map, and staff surveys are shared.


      Twenty-eight patients received elastomeric devices during the 12 months of data collection. All 28 patients who required a continuous peripheral nerve block (CPNB) for pain management following foot and ankle reconstruction surgery received their block via an elastomeric device rather than an electronic hospital infusion pump. All patients and caregivers expressed positive satisfaction with pain management after hospital discharge. No patient with an elastomeric device required scheduled opioids for pain management by the end of their hospital admission. LOS on the orthopedic inpatient unit for foot and ankle surgery decreased by 58%, representing an estimated 29 days and $27,557.88 saved. A majority (96.4%) of staff survey respondents reported feeling satisfied with their overall experience working with an elastomeric device.


      The successful implementation of a pediatric ACPNB program has led to positive patient outcomes, including a significant decrease in hospital LOS and health system cost savings for this patient population.


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        • Ganesh A
        • Rose JB
        • Wells L
        • et al.
        Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children.
        Anesth Analg. 2007; 105: 1234-1242
        • Gurnaney H
        • Kraemer W
        • Maxwell l
        • Muhly WT
        • Schleelein L
        • Ganesh A
        Ambulatory continuous peripheral nerve blocks in children and adolescents: a longitudinal 8-year single center study.
        Anesth Analg. 2014; 118: 621-627
        • Simic D
        • Stevic M
        • Stankovic Z
        • et al.
        The safety and efficacy of the continuous peripheral nerve block in postoperative analgesia of pediatric patients.
        Front Med. 2018; 5: 1-4
        • Ludot H
        • Berger J
        • Pichenot V
        • Belouadah M
        • Madi K
        • Malinovsky J-M.
        Continuous peripheral nerve block for postoperative pain control at home: a prospective feasibility study in children.
        Reg Anesth Pain Med. 2008; 33: 52-56
        • Visoiu M
        • Joy LN
        • Grudziak JS
        • Chelly JE
        The effectiveness of ambulatory continuous peripheral nerve blocks for postoperative pain management in children and adolescents.
        Pediatr Anesth. 2014; 24: 1141-1148
        • Taylor MJ
        • McNicholas C
        • Nicolay C
        • Darzi A
        • Bell D
        • Reed JE.
        Systematic review of the application of the plan-do-study-act model to improve quality in healthcare.
        BMJ Qual Saf. 2014; 23: 290-298