A retrospective case series and technological review of post-surgical analgesia for orthopedic surgery using a smart connected infusion pump: an opioid-sparing protocol

Background Opioid-sparing analgesia (OSA) strategies aim to reduce perioperative opioid exposure while maintaining effective pain control. Continuous peripheral nerve blocks (cPNBs) supported by ambulatory infusion pumps have demonstrated efficacy in reducing opioid consumption, yet data on electronic infusion systems in the home environment remain limited. Methods A retrospective, single-center, uncontrolled feasibility series evaluated the performance of a smart connected electronic infusion pump within a multimodal opioid-sparing postoperative analgesia protocol in routine clinical practice. Twenty orthopedic surgery patients with continuous peripheral nerve catheters and patient-controlled boluses received an initial 20 mL nerve block (adductor canal, with or without supplemental iPACK, or interscalene/infraclavicular brachial plexus) followed by 0.2% ropivacaine via a standardized infusion regimen (8 mL/h basal rate with 3 mL patient-controlled bolus, 30-min lockout). Results Postoperative opioid consumption over 3 days varied by procedure type and regional anesthesia technique. Overall, a median of 15 MME (IQR: 0–39.4 MME, range: 0–90 MME). Shoulder surgery patients (n = 12, 60% of cohort) receiving interscalene brachial plexus catheters had a median consumption of 15 MME (IQR: 0–45 MME, range: 0–90 MME), with 42% (5/12) using no opioids. ACL reconstruction patients (n = 3, 15% of cohort) receiving adductor canal blocks had even lower consumption, with a median of 0 MME (range: 0–22.5 MME) and 67% (2/3) reporting no opioid use. Patients undergoing other procedures (TKA, PFL and humerus fracture; n = 4, 20% of cohort) had a median consumption of 41.25 MME (range: 7.5–52.5 MME), and the thumb surgery patient (5%) reported no opioid use. Seventeen patients (85%) completed the full programmed infusion; the remaining three (15%) discontinued early due to catheter dislodgement, not pump malfunction. All alarms were resolved at home without interrupting therapy, and no pump-related discontinuations occurred. Conclusion In this small, real-world retrospective, single-center, uncontrolled feasibility series, a smart electronic infusion pump reliably delivered opioid-sparing perineural analgesia within a multimodal OSA protocol following orthopedic surgery in ambulatory and home settings, with no pump-related discontinuations and successful patient management of alarms. These observations support feasibility; analgesic adequacy was assessed only as a binary outcome (pain controlled or uncontrolled). Future comparative studies evaluating different ambulatory infusion platforms would help identify optimal device characteristics for home-based perineural analgesia.