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* From the Departments of Anesthesia and
Orthopedic Surgery and Sports Medicine, London Health Sciences Centre, University Campus, University of Western Ontario, London Ontario, and
Department of Anesthesia, McMaster University, Hamilton, Ontario.
Address correspondence to: Dr. S. Ganapathy, Department of Anesthesia, London Health Sciences Centre, University Campus, 339 Windermere Road, London, Ontario, N6A 5A5 Canada. Phone: 519-685-8300, Ext. 8500 or 35022; Fax: 519-6726576; E-mail:sganapat{at}julian.uwo.ca.
Purpose: To report our experience with the use of the (Eclipse®) elastomeric pump for ambulatory Patient Controlled Regional Analgesia (PCRA)
Method: After a pilot study using this device in patients admitted to the hospital, seven patients received PCRA at home using the elastomeric pump. Patients with a variety of continuous regional anesthetic blocks were sent home with written and verbal instructions regarding the use of this device, boluses, side effects of local anesthetics and removal of block catheters. Patients were contacted daily to collect data with regards to the efficacy of the block, problems associated with the use of this device and their satisfaction with the method of analgesia.
Results: During the pilot study there were two catheter disconnections requiring rescue analgesics. Two patients had the entire contents of the bulb delivered over several minutes. Among the seven patients receiving PCRA at home, one patient had to be admitted to the hospital. One patient had block catheter slip out during transit. The volume delivered could not be measured. Patients found it difficult to know if the drug had been delivered. Three patients noted that the pumps were empty earlier than expected. One patient found it difficult to change the bulb. No patient had difficulty with catheter removal or with bolusing.
Conclusions: PCRA offers excellent postoperative analgesia at home. Elastomeric pumps facilitate PCRA but are imprecise with drug delivery and may not be safe for epidural infusions. The safety of this device for peripheral nerve blocks should be evaluated further.
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