No pain, no gain -- no more. Surgery and pain have always gone together, but thanks to medical advances at the Hospital of the University of Pennsylvania, painless surgery may be on its way. HUP now performs increasing amounts of surgery with minimal or no use of anesthesia. Although this sounds like it would increase pain, anesthesiologists at HUP have taken other measures to prevent pain. The newest method allows patients to administer local anesthetics and analgesics, or pain killers, when they feel necessary. The patient's post-operative control, or Patient Controlled Analgesia, allows the patient to control their medicinal intake, according to Kathleen Veloso, assistant professor of anesthesia and director of the Anesthesia Pain Management Service at HUP. HUP is one of the first hospitals to use this form of pain management for surgeries such as hip, knee, urologic, and gynecologic operations, where general anesthesia is not necessary, Veloso added. The overall cost to the hospital also appears to be decreasing because of the treatment, since patients are discharged earlier. The medicine, which is administered by the patients' pushing a button, travels down an epidural catheter -- a small wire-like intravenous tube -- into the fluid sac outside of the spine. Transmission to the spine blocks the pathways that send pain signals to the brain, according to HUP spokesperson Seanna Walter. "Patient recovery time is faster," Walter said. "They can usually walk sooner" than procedures involving the use of general anesthesia. Small amounts of the drugs are given continuously through the epidural catheter to the patient, and patients then have opportunity to administer additional amounts more as they deem necessary, according to Veloso. "We like to leave the epidural in after surgery," Veloso said. "This allows us to deposit numbing medicines and analgesics in different concentrations." And the risk of overdose is not a threat because the pump is programmed to release up to a specified amount of medication over a prescribed time period. In addition, anesthesiologist check in with the patients at least three times a day to ensure that all is going well and that the right amount of medicine is being administered, according to Walter. Pain killers usually kick in anywhere from five to 20 minutes after being administered, according to Veloso. "I like to use medicine that patients can feel in five minutes," Veloso said. "When patients are coughing or doing breathing exercises, they want [relief] now." Use of epidural analgesia as opposed to general anesthesia also reduces post-operative complications such as blood clots to the lungs, congestive heart failure, heart attacks, and even death, according to a study done by Randall Carpenter in Seattle, Washington. PCA is used across the country for procedures such as cesarean sections.
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