Patients administer own painkiller Quicker recovery noted at Hopkins

November 28, 1990|By Jonathan Bor

It wasn't an Olympic moment, but Ann Morrill felt triumphant.

Ten hours after she left surgery on a gurney, she walked around her room while holding her brand-new 8-pound baby Elizabeth Ann in her arms.

The knife-like abdominal pains that often follow Caesarean sections can make scenes like this impossible for another day or two. But at Johns Hopkins Hospital, doctors have found that patients feel less pain, get on their feet faster and leave the hospital earlier if they are given control over their own pain medication.

So when Dr. Morrill, the patient who also happens to practice medicine at Hopkins, felt stabbing pains after surgery, she didn't have to yell for help, wait for a nurse to prepare an injection and endure a half-hour for the medication to take effect.

Instead, she flicked a button on a hand-held control. That signaled a battery-operated pump clamped to a pole to deliver an extra pulse of pain-killing drug through a tube into the epidural region around her spine. A few minutes later, the pain was gone.

"I was up walking the corridors the next night [after surgery] without any discomfort at all," Dr. Morrill said yesterday, a day after she was disconnected from the pump. She delivered her baby Saturday and plans to go home today.

Patient-controlled analgesia, as the technology is called, is slowly taking the sting out of some surgical recoveries in hospitals across the country, doctors say. At Hopkins, doctors first introduced it to Caesarean patients about a year ago. Soon, the practice was extended to patients recovering from gynecological surgery, such as hysterectomies and from urologic procedures, such as prostate surgery.

In January, it will be offered to patients recuperating from orthopedic surgery, according to Dr. Rhonda L. Zuckerman, a Hopkins anesthesiologist.

Dr. Zuckerman said its benefits go beyond giving patients faster pain relief and enabling them to leave the hospital earlier. Patients who feel less pain, she said, are able to move sooner and take deep breaths -- thereby preventing the respiratory infections that can occur when pain-riddled patients cannot expand their lungs.

Preventing crippling infections is so important, said Dr. Zuckerman, that she doesn't hesitate to adjust the pump to deliver heavier doses of pain-killing narcotic if patients report XTC they are not getting enough relief.

The type of pain control used by Dr. Morrill is a natural extension of what has occurred in operating rooms for many years. There, anesthesiologists wanting to numb a patient but keep her awake during surgery often chose to deliver pain-killing medication through a tube inserted into the epidural region of the lower spine.

Several years ago, anesthesiologists took this one step further. They left the tube in place for a few days after surgery -- using it to pump a continuous trickle of pain-relieving medication to patients in their hospital rooms.

More recently, they added a new twist: Patients get the steady trickle, but are empowered to give them selves an extra measure of pain relief at the flick of a switch. However, patient power has its limits: A doctor programs the computerized pump to deliver the extra jolts at fixed intervals only and in limited amounts.

In Dr. Morrill's case, she could call for extra medication every 10 minutes. Flicking the switch a moment too soon accomplished nothing.

Last spring, the Greater Baltimore Medical Center started offering a different kind of patient-controlled pain relief -- one that delivers medication into a vein rather than into the epidural region of the spine.

Dr. Richard Epstein, an anesthesiologist there, said the practice has significantly improved the patient's hospital experience, which is usually marked by a feeling of helplessness.

"When patients come to the hospital, there is a loss of control," he said. "They're putting themselves in the hands of a lot of different people."

This may explain the rapid acceptance of this technology among patients who are offered it. At Hopkins, where doctors have offered the epidural variety to several hundred Caesarean patients in 16 months, almost all accepted it.

"I can hardly think of a patient who said she didn't want it," Dr. Zuckerman said.

Baltimore Sun Articles
Please note the green-lined linked article text has been applied commercially without any involvement from our newsroom editors, reporters or any other editorial staff.