Abstract
Purpose
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.
Design
An ACPNB program was developed and implemented for pediatric patients undergoing foot
and ankle reconstruction surgery.
Methods
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.
Findings
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.
Conclusions
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.
Keywords
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References
- Continuous peripheral nerve blockade for inpatient and outpatient postoperative analgesia in children.Anesth Analg. 2007; 105: 1234-1242https://doi.org/10.1213/01.ane.0000284670.17412.b6
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Article info
Publication history
Published online: May 10, 2023
Publication stage
In Press Corrected ProofFootnotes
Conflict of Interest: None to report.
The ACPNB Quality Improvement Project team, including the authors, received the SickKids’ Utilization Management Committee Resource Stewardship Award. The award amount of $500 will go toward enhancing the caregiver education package on the elastomeric device.
Identification
Copyright
© 2023 American Society of PeriAnesthesia Nurses. Published by Elsevier Inc. All rights reserved.
