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LETTER TO THE EDITOR

Concerns with Nerve Blocks at Home

Department of Anesthesia, Robert Wood Johnson Medical School, New Brunswick, NJ, sklein{at}umdnj.edu

To the Editor:

We would like to make two observations regarding the well-written article of Ilfeld and Enneking (1).

1. There is the excellent possibility that, at least initially, when a bill is rendered to a third-party payer for reimbursement for this type of service, only more paperwork will result. In our experience, much confusion results from having to consult seldom-used (in anesthesia) CPT/HCPCS code books. Meanwhile, of course, reimbursement will be held up. We therefore recommend that to the extent possible, fees be negotiated in advance, with terms and extent of service as clear as can be.

2. A programmable infusion pump is not a bandage or a splint; it has an active component that can adversely respond to the environment. Therefore, to some extent, it increases the liability of the practitioner who is responsible for set-up and maintenance. In one sense, although we are not "Tools are Us," we are "renting" a device to a patient that can act in a few cases in unpredictable ways. This should not deter use of this treatment modality, which appears to have excellent potential, but should simply put us on guard to document and follow rigorous protocols for use.

Reference

1. Ilfeld B, Enneking F. Continuous peripheral nerve blocks at home: a review. Anesth Analg 2005;100:1822–33.[Abstract/Free Full Text]

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