Podiatrist's Patients Remain Awake During Surgery, Yet Stay Pain-Free With High-Tech 'Pain Pump'

When Dr. Peter J. Bregman performs surgery on a podiatry patient today, he attaches a small, microchip-controlled ambIT(R) infusion pump to a thin tube that bathes the nerves leading to the patient's foot in anesthetic. His patients stay awake during surgery involving an extremely sensitive area, yet remain completely pain-free. After surgery, the pain pump -- which hangs from a belt pack and runs on two AA batteries -- stays with the patient to ensure a comfortable recovery at home.

Bregman is pioneering this new pain-control technique for podiatry surgery in Massachusetts because it brings a variety of medical benefits, he said. Unlike the sledgehammer of general anesthesia, this new technique delivers a local anesthetic precisely to targeted, limb-specific nerves, providing profound pain relief by blocking signals to the brain but leaving the patient fully conscious.

Because general anesthesia suppresses activity in the entire central nervous system, a patient's vital signs must be constantly monitored during surgery. Then, hours after surgery when general anesthesia wears off, the patient begins taking pain medication which may include morphine or other addictive drugs. The analgesic effect of a narcotic pill peaks and gradually disappears so pain comes and goes. Narcotics may also cause nausea, vomiting, constipation and sedation.

"But the local anesthetic we use with this new technique is like what your dentist uses, except instead of numbness for one-and-a-half hours, ours produces numbness for eight to 24 hours," said Bregman, who trained at Dellon Institute for Peripheral Nerve Surgery in Baltimore.

What makes this sophisticated pain-control technique possible is a new generation of innovative, compact electronic pumps made by Sorenson Medical in Salt Lake City. The ambIT(R) pumps allow a physician to continually deliver a precise amount of mild anesthetic directly to the source of the pain, rather than numbing their entire body. Sophisticated microchip technology allows the physician to easily program an exact medicine flow rate and duration appropriate to each patient's needs.

Many of Bregman's patients suffer from nerve disease of the lower extremities caused by diabetes, and Bregman performs more lower extremity surgeries on this type of patient than any other physician in Massachusetts. He also uses the new surgical technique on arthritic patients who need corrective surgery and on patients with bunions. "Nine out of 10 of my surgeries are completely pain-free now," said Bregman.

"The greatest benefit of the new pain pumps and the nerve-block surgical technique is that the patient is apt to stay pain-free and to move around more quickly after surgery," Bregman said. "The more active a patient is, the better prepared they'll be for rehab and the more quickly they'll heal."