Procedure
Recently, pain pump use after arthroscopic surgery (particularly shoulder surgery) has gotten a lot of press. Pain pumps are special devices that continuously pump an anesthetic medication (typically bupivicaine) into your shoulder after surgery via a small catheter inserted at the time of surgery. Often the pump itself is not that complicated; it may simply be a special rubber ball that gently and continuously squeezes medication into the area for 2-3 days. The advantage of this device is that it can significantly reduce pain for certain procedures. The pain pump is removed by the patients when they remove the dressings; the tiny catheter (about 1 mm wide, but long), typically slips out very easily. We give all our patients instructions how to do this and thousands have done so without difficulty.
A few years ago, animal studies showed that high concentrations of the anesthetic used in these pumps could be damaging to cartilage. Recently, there have been reports of cartilage damage in humans after surgery with these high doses of anesthetic. There continue to be ongoing studies to determine the safety profile for these types of anesthetics in humans after surgery.
Treatment
As of the earliest animal reports, Dr. Farjo felt it safest to stop the use of these pain pumps near cartilage. So, for example, if you are having a shoulder surgery that involves only joint work (e.g., “Arthroscopic Bankart”, or “Arthroscopic suture capsulorraphy” for tightening ligaments) you will not receive a pain pump and instead we will treat your pain with several other methods we have available. However, much shoulder surgery involves work outside the joint — for example the removal of bone spurs and rotator cuff repairs — in this scenario, we do still use the pain pumps because they are not placed near the cartilage. Rather, they are in a different space called the “subacromial space”.
Please be assured that Dr. Farjo keeps abreast of all the latest scientific studies regarding all aspects of arthroscopic surgery, including the use of pain pumps, and will modify his practice accordingly if medical research shows that it is necessary. However, he also relies on his experience of thousands of arthroscopic shoulder surgeries to make the proper decisions for his patients.
Having a pain pump is always a personal choice; if you do not feel comfortable with having a pain pump for any reason, please let us know and we will use other methods to control your pain.
