New Treatment Techniques, Equipment Help Reduce Pain

Hand-held Device Gives Medication Automatically

February 03, 1991|By Amy L. Miller | Amy L. Miller,Staff writer

Vernon Faid still marvels that he never experienced any pain after his kidney operation last year.

And he says he owes it all to the analgesia pump his doctor prescribed for pain relief.

"It was a very wonderful thing," said Faid, 83. "There was not one iota of pain. When I had a back operation they gave me regular shots of codeine, and I was still always in pain."

The pump, also known as patient-controlled analgesia, allows patients to control the amount of pain medication they receive.

The small, hand-held computer-- connected to the person by an intravenous tube -- can be programmed to give a steady flow of medication, a dosage on patient request, or both.

"It's like having a nurse standing by your bedside, ready to serve you at any time of the day," said Dr. Renaldo Madrinan, chairman of Carroll County General Hospital's department of surgery.

"In an ordinary situation, it may take 15 minutes to an hour to get pain relief, and we felt this was not acceptable," he said.

Although a patient may give himself a small dosage at any time, the computerhas a safeguard preventing an overdose. The computer automatically records the amount and frequency of medication and will not release any if a patient requests more than his limit.

The computer also is equipped with physical and electronic locks to prevent a patient fromtampering with the medication.

"Only a certified nurse can accessthe computer," said Dr. S. A. Zamaria, an obstetrician/gynecologist at CCGH and St. Joseph's Hospital in Towson, Baltimore County.

Studies have shown that patients are not likely to become addicted to the drugs if they use the pump, said Glenn Feroli, a pharmacist at CCGH.

"It's essentially not a concern," he said, adding that he had attended several seminars on the topic. "It's really more of an education issue."

So far, the pump -- which has only been available at CCGH for about six months -- is used for patients who have had major surgery and for some cancer patients. Expansion to other types of patients is being investigated, Zamaria and Madrinan said.

"We haven't used it for labor and delivery, but it's on our future agenda to lookinto its being used if possible," said Zamaria.

Both doctors saidpatients take less medication when they use the pump than when the pain medication is administered by others.

"If you give a patient 15 milliliters every four hours, he is knocked out for a time and the pain comes back," Madrinan said.

Continuously feeding that same patient two milliliters of morphine every hour and allowing him to givehimself an extra milliliter and a half every hour is less medicationoverall, he said.

"If you use your mathematics, that's only 14 milliliters," he said, adding that most of his patients only used the continuous drip of morphine. "You try to keep (the patient) on the edge without pain and without having to give more shots."

Faid said this was true in his case.

"There was no effort on my part, and I was completely without pain," he said. "I never had to push the buttononce."

The pump, which can be carried on a small pouch around thepatient's waist, also speeds the recovery process.

"For patients that have to go to the physical therapist, it helps immensely," said Kathy Noonan, CCGH's clinical manager of the post-anesthesia care unit. "The medication is at a constant level, so patients are not whacked out for the first half hour, and they can do more."

Madrinan said, "Pain is not just a matter of being a wimp. It doesn't allow you to breathe normally and it retards physical functions. (Using the pump) also becomes a medical benefit, since the patient is able to walk and decreases the possibility of complications.

"People are gettingout of bed on the first or second day (after an operation), rather than the third or fourth day, and leaving on the fourth or fifth day rather than the seventh or the eighth."

The pump, which doesn't cost patients any more to use than traditional injections, is covered bymost major insurance companies, Noonan said.

"The pharmacy sets the price according to how much morphine the patient takes," she said."We also checked with insurance companies and, so far, they've been paying for it."

The pump also signals CCGH's increased attention to patient comfort, Madrinan said.

"A nice bed, a nice room, to lots of people that means something," he said. "The present administration is paying a tremendous amount of attention to patient amenities, more than it did in the past.

"This is an important step in that direction."

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.