Pumps are making gains in pain

Regional nerve block lets patient be alert and assist in own recovery

Brian Wilhelm had the back of his leg blown off last October by a rocket-propelled grenade while serving in Iraq. But 20 minutes after American surgeons operated on him, he was conscious and joking with his buddies. And he was able to help with his own evacuation to a hospital in Germany and later back to the United States.

It's a story that Lt. Col. Chester "Trip" Buckenmaier III, chief of Army Regional Anesthesia and Pain Management Initiative and a physician at Walter Reed Army Medical Center, likes to tell for many reasons. For one thing, it was a medical first in a battleground situation.

Instead of knocking Wilhelm out with narcotics like morphine that are the mainstay of pain control during a conflict, Buckenmaier did a peripheral nerve block using a medicine-infusion pump made in West Jordan by Sorenson Medical.

"Pain is sort of undertreated and probably not given its full due," said Buckenmaier in a phone interview

The attitude has been that if you have surgery or you're injured in battle, you can expect pain and you'll have to live with it, he said. "Morphine and narcotics have been the mainstay in pain medicine for hundreds of years. Morphine was synthesized in 1803, and we are still relying on the same stuff. I'm not criticizing what we do in medicine. We do medicine better than anyone in the world. But that doesn't mean we can't do better."

The heart of Sorenson Medical's ambIT is simple microchip technology that controls the amount of medication delivered in a certain amount of time, but at a much lower cost than most pumps.

The difference is ambIT is designed for one specific purpose, whether it's to deliver anesthesia to a region of the body (as opposed to general anesthetic), or antibiotics or chemotherapy. For regional pain control, a catheter is placed at the affected nerve bundle site and then a novocaine-like medicine, or novocaine itself, is infused into the area to block the pain message from reaching the brain, without the sedating effects of a general anesthesia, said Thomas Orsini, chief operating officer and president of Sorenson Medical.

The pump is lightweight, the size of a remote control, runs with standard AA batteries and costs about one-fifth to one-tenth the cost of most infusion pumps. The cost is held down by the simplicity of the device and the fact that it's intended to last 18 months to two years then be thrown away. Still, it has "bells and whistles," including occlusion alarms, audible alerts, a filter to screen out air, and technology to prevent free flow so a patient can't get too much of the medication.

The catheter itself works like a tiny soaker hose, delivering the medication over the designated area in an even flow, Orsini said, and the volume accuracy is similar to that of any infusion pump.

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