|MP 7.01.94||Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump|
|Original Policy Date
|Last Review Status/Date
Reviewed with literature search/2:2003
|Return to Medical Policy Index|
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Local delivery of analgesia to operative sites is designed to reduce postoperative pain, while limiting systemic side effects of analgesia. Additional benefits include reduced need for oral narcotics, decreased incidence of breakthrough pain, and faster return to normal activities. Drug delivery can be regulated through the use of simple disposable elastomeric pumps filled with analgesics such as ropivicaine or bupivacaine, attached to a variety of catheters that provide continuous delivery of the drug to the surgical site. Catheters may contain multiple openings so that the drug seeps into the operative wound all along its length, similar in concept to a “soaker” hose. Elastomeric infusion pumps are designed to deliver drugs for up to 5 days followed by removal of the catheter. Use of elastomeric pumps to deliver local analgesia has been investigated in the following postoperative clinical situations:
- Orthopedic procedures, such as repair of the anterior cruciate ligament
- Urology procedures, such as prostatectomy
- Plastic surgery procedures
- Obstetrical/gynecologic procedures, such as cesarean section
- Gastrointestinal surgery procedures, such as hemorrhoidectomy or gastric bypass
- Thoracic surgery procedures, such as thoracotomy
- Cardiovascular surgery procedures, such as sternotomy
Trade names of elastomeric pumps and associated catheters that have received approval for marketing from the U.S. Food and Drug Administration (FDA), include, but are not limited to, Infusor System™, On-Q® Post Op Pain Relief System, On-Q Soaker™ catheter delivery system, and the Pain Buster ™ Pain Management System.
Continuous infusion of anesthesia to operative wound sites using an elastomeric pump may be considered medically necessary as a technique for postoperative pain control for surgeries typically requiring oral or parenteral narcotics for pain relief.
No applicable information
BlueCard/National Account Issues
In many instances, continuous infusion of operative sites will be a component of outpatient or ambulatory surgery. Therefore, in some contracts, the cost of the elastomeric infusion pump may be included as part of the facility fee.
Several randomized, blinded placebo-controlled trials suggest that the use of continuous infusion of analgesics to operative wound sites results in improved pain control and decreased use of systemic opioids. For example, Hoenecke and colleagues reported on a trial that randomized 26 patients undergoing repair of the anterior cruciate ligament to receive either saline infusion or continuous infusion of bupivacaine for 48 hours after surgery. (1) Compared to the control group, a significant reduction in pain scores and decreased consumption of narcotics were observed. In a similarly designed study of 36 patients undergoing cesarean delivery, Givens and colleagues reported that while the pain scores were similar in the 2 groups, the narcotics requirements were significantly less in the treatment group. (2) Cheong and colleagues compared pain scores in patients undergoing laparotomy who were randomized to receive either patient-controlled anesthesia with intravenous morphine or continuous wound infusion with bupivacaine. (3) There was no difference in pain scores between the groups, suggesting that continuous wound infusion can be an alternative to parenteral opioids. Finally, in a randomized placebo-controlled trial of 72 patients undergoing outpatient hernia repair, Oakley and colleagues reported improved pain control among patients assigned to receive local anesthetic infusion compared to those assigned to a placebo group. (4)
- Hoenecke HR, Pulido PA, Morris BA et al. The efficacy of continuous bupivacaine infiltration following anterior cruciate ligament reconstruction. Arthroscopy 2002; 18(8):854-8.
- Givens VA, Lipscomb GH, Meyer NL. A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 2002; 186(6):1188-91.
- Cheong WK, Seow-Choen F, Eu KW et al. Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy. Br J Surg 2001; 88(3):357-9.
- Oakley MJ, Smith JS, Anderson JR et al. Randomized placebo-controlled trial of local anaesthetic in day-case inguinal hernia repair. Br J Surg 1998; 85(6):797-9.
|HCPCS||A4305||Disposable drug delivery system, flow rate of 50 ml or greater per hour|
|A4306||Disposable drug delivery system, flow rate of 5 ml or less per hour|
|Type of Service||Surgery|
|Place of Service|
Anesthesia, continuous local to operative site
Continuous local delivery of anesthesia to operative aite
Elastomeric infusion pump, operative aite
Infusion pump, elastomeric, postoperative pain control
Operative site, elastomeric pump for delivery of local anesthesia
Postoperative pain relief, elastomeric infusion pump
|10/9/03||Add policy to Surgery section||New policy|
|11/9/04||Replace policy||Coding added – A4305 and A4306.|