Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

MP 7.01.94 Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump

Medical Policy
Section
Surgery
Original Policy Date
10/09/03
Last Review Status/Date
Reviewed with literature search/2:2003
Issue
3:2003
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

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.


Policy

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.


Policy Guidelines

No applicable information


Benefit Application

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.


Rationale

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)

References:

  1. 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.
  2. 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.
  3. 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.
  4. 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.

 

Codes

Number

Description

CPT  No code 
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   


Index

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
Pain buster
Postoperative pain relief, elastomeric infusion pump
On-Q


Policy History

Date Action Reason
10/9/03 Add policy to Surgery section New policy
11/9/04 Replace policy Coding added – A4305 and A4306.


Search for Policies

Policy Feedback