New tool against pain

Senior Pastor Marvin Bedenbaugh is passionate about three things: Charlestowne Methodist Church in West Ashley, his family and golf.

In that order.

As trouble with his knees progressed, he said, "I got to where I had a lot of problems with any of it."

A football player in high school, then softball in college, Bedenbaugh tore his ACL, a major knee ligament, in 1976. Since then, he has had three surgeries on his right knee, two major reconstructions and an arthroscopic procedure to diagnose complications with his joint.

When doctors told him he needed a fourth procedure, a total knee replacement, he was apprehensive.

"Knee surgeries are extremely painful," the 53-year-old said. He had visited people in the hospital who had total knee replacements. "You could see the agony on their face."

But this time around, doctors had another tool in their arsenal of pain management: a pain pump that blocks nerves on demand and reduces the need for narcotics.

Nerve-block systems have been growing in popularity during the past 10 years and have become mainstream in area hospitals in the past few years.

Donna Daws, Trident Medical Center's director of surgical services, said, "It is a continuum of a trend that's been around awhile, but this allows you to have a continuous infusion without an electronic medication pump."

Following previous surgeries, Bedenbaugh had injections every four hours, but the pain pump can hit every five minutes, he said. "It exceeds the other pain management."

The pumps are made by several manufacturers and work by infusing a local anesthetic continuously to the nerve, blocking the pain circuits that travel from the surgical area to the brain.

The catheter is about the size of an epidural and is inserted before surgery with local sedation. Some patients can wear the systems home following surgery and remove the catheters themselves.

Using ultrasound to insert the catheter right next to the nerve is a recent advancement in the efficiency of pain pumps, area doctors said.

Dr. Joseph Rodrigo, an anesthesiologist at Roper Hospital, said the pump is used for about 98 percent of orthopedic surgeries. The device has reduced patient-reported pain scores from an 8 out of 10 to a 1.5 out of 10.

Since the catheter is parked next to the nerves that normally would carry pain to the brain, patients depend less on narcotics, said Dr. Charles Weinheimer, an anesthesiologist at East Cooper Medical Center.

Narcotics affect the entire body and have side effects such as nausea, itching and slow bowels, Weinheimer said. Pain pumps do not eliminate the need for narcotics but do reduce it, he said.

Other benefits include decreased length of stay and getting into physical therapy faster. "If you're unable to do physical therapy and range of motion, you get scar tissue built up in there and a frozen joint," Rodrigo said.

Risks are infection, bleeding and nerve injury, doctors said.

Major manufacturers include I-Flow Inc., the Lake Forest, Calif., maker of ON-Q C-bloc, and Stryker Corp. in Kalamazoo, Mich. In the past year, lawsuits have sprung up across the country suing manufacturers for damage to cartilage.

Rodrigo said that in the higher profile lawsuits, the catheters were placed into the joints. "We place along the nerves," he said. "We're nowhere near the joint."

Bedenbaugh hit the golf course six weeks after his March 23 replacement surgery.

"Now, I'm getting to the point where I can pursue my ministerial work here, am more available to my wife and children and am already back to shooting irons," he said. "You go from agony to no pain overnight. It's a very strange thing."