Post op Local Anasthetic for Pain and Bowel Sounds

[BTC2019]

Good morning all,

This is my first clinical and experience with first day post-op patients and I am learning (ish) a lot quickly but looking for some more guidance and resources so I am better prepared.

I just had a patient who was post-op bowel repair and had a local bupivacaine injection device. I had never seen those before. Never even heard of them- our instructor was quit surprised and told me to look them up. Our nursing texts have a single paragraph dedicated to them about why they may be used but no parameters to monitor or anything.

I did a quick literature search and found some info on infection rates and prevention but also want to know some more practical information. Such as, if this is in place post bowel surgery, and it normally takes 3-5 days for the large intestine to start functioning again, but the anesthetic runs for 3 days- does that add 3 days on to the bowel function recovery time? Does this extend the period of time the patient will be NPO post surgery? Other things I should know(/be educated on) when educating "my" patient?

Any experiences, directions to resources or blatant "duh" statements appreciated. Thanks!

[Rose_Queen, BSN, MSN, RN]

Local anesthetic infusers, such as the OnQ pain pump, are for incisional pain. It has no or very minimal effect on the abdominal organs as they are placed sub-q, not into the abdominal cavity. These are also non-narcotic, meaning that the bowel effects of narcotic meds can be lessened as there's less need for them. Most pain from abdominal surgery is from the incision.

[murseman24, MSN, CRNA]

Only thing you need to know is that more local anesthetic is not to be injected b/c of the risk of toxicity (no reason more should have to be injected anyways). It should help with post op pain and reduce opioid consumption. S/S of local anesthetic toxicity are circumoral numbness, ringing in the ears, blurred vision, numb tongue, all the way to seizures and cardiac collapse. This really shouldn't happen with one of these pumps, but I guess it is POSSIBLE. If this happens the treatment is to administer intralipid. If they are unfamiliar with the treatment then they should page the surgeon or anesthesia (they put the pump in).