My name is Madison Pettigrew. I have been a Registered Nurse since 2009 and have been a post-op, recovery room and ICU nurse since 2012. I have worked in a Level 1 Trauma center since 2011 and primarily have recovered trauma, orthopedic and burn patients. During the recovery phase, we tend to use excessive amounts of narcotics in my hospital. Our typical patient will require double to triple the standard amount of narcotics secondary to the extensive injuries and complicated surgeries they have endured. I began working with Dr. Jerry Jones in 2014. He is a zealous advocate for nerve blocks to manage post-operative pain. In my practice with Dr. Jones, most patients have experienced near complete or complete pain control through blocks alone and have required minimal to no narcotics in the post-operative phase. Patients are no longer waking up from surgery in excruciating pain, requiring enough narcotics that they are basically rendered comatose. Patients are rarely requiring supplemental oxygen any longer. They are able to ambulate and mobilize sooner and quickly return home due to the decreased amount of narcotics being used. The cutting edge blocks Dr. Jones has provided his patients has vastly improved their pain control, length of stay and overall satisfaction with their surgical and post-operative experience. He has developed a highly effective technique to apply a block for almost any surgery imaginable. I have seen him apply blocks for surgeries involving any extremity, hips, shoulders, thoracic/lung surgeries and even abdominal surgeries.
In 2002, I personally had a shoulder surgery that was very painful, requiring me to utilize a large amount of narcotics at home. Despite all the narcotics that I used, I was still in a great deal of pain. I felt like the Doctors had done all they could do to control my pain but at the time I was unaware of the nerve blocks Dr. Jones could offer. Since becoming and recovery room nurse, I have recovered patients with the same operation I endured. Some received nerve blocks and some have not. The patients who had the benefit of Dr. Jones nerve blocks did not require any narcotics and were much more comfortable than the patients who did not get the benefit of a nerve block. One example, my uncle and aunt both had orthopedic operations on their ankle. My uncle’s procedure was done before Dr. Jones came to my hospital. Uncle Joe was admitted to the hospital for IV pain control and still had a very uncomfortable and painful experience requiring large amounts of narcotics even after going home. My Aunt Terri, however, had the exact same procedure done months later, received a block from Dr. Jones and was able to go home the same day. She never required any narcotics in the hospital or at home. The block along with an occasional non-narcotic NSAID at home was enough for her to have adequate pain control. In fact, I feel so strongly about the effectiveness of these blocks, if I were to have surgery again, I would make sure I received a block. If the anesthesia group managing my surgical experience could not offer me a block, I would electively postpone my surgery and find a group who could offer a block to control my post-operative pain.
Madison Pettigrew, RN
Regional One Health
As an orthopedic nurse, pain control for my patients is of major importance. When I first learned about the nerve block program, I wasn’t quite convinced that they would work better than oral or IV pain medications. It didn’t take me long to change my mind! These patients come back from surgery talking and ready to eat. Setting up the nerve block literally takes about five minutes! Patients no longer push the call light continuously asking for pain medication and even get out of bed and walk the same day of surgery. Side effects of narcotics such as constipation, added fall risks, and nausea are no longer an issue, which is great!!
Patients who have had abdominal surgeries and have a nerve block vs those who do not have a nerve block are like night and day. Patients with the nerve block are not scared to get up and walk around, decreasing the chance of post op complications.
I’ve witnessed Dr. Jones’ compassion not only for this program, but for his individual patients and would recommend him to anyone! He goes above and beyond for his patients and has such knowledge and expertise for this field!
If I were having any type of orthopedic or abdominal surgery, I would ask two questions:
1. May I have a nerve block?
2. Can Dr. Jones do it?
Chasity Criswell, Orthopedic Nurse
Regional Hospital of Jackson
I work in Outpatient Surgery and have been here about 15 years. Before our anesthesia group began using continuous peripheral nerve blocks on ACL repairs, shoulder repairs, and ankle surgeries, all of those patients had to be admitted to the hospital post-op for pain control.
Now, with the advent of the continuous peripheral nerve blocks, we almost always are able to discharge the patients home on the same day. They rarely ever need narcotic therapy, and they seem very pleased with the level of pain control when we call them at home the next day. The difference in the amount of pain experienced by the patient in these procedures is phenomenal!
Kim Dougherty, RN
Horizon Medical Center
Continuous Peripheral Nerve Blocks are great for post-operative pain control! In the Recovery Room, we’ve noticed that we are able to spend time with patients recovering from anesthesia instead of trying to catch up on pain control. Our patients are coming in to the Recovery Room now with little or no pain. Patients get fewer narcotics which means quicker recovery and quicker release from the hospital. Receiving fewer narcotics is especially important with patients who have a higher tolerance to pain medications for whatever reason. They are able to enter the Recovery Room with little to no pain, and we don’t have to be worried about them hurting too much or about the consequences of giving too much pain medicine. With the good pre-operative teaching and good assessments in the Recovery Room that we are learning from Dr Jones, I can quickly determine the patient’s needs, and I know how to manage the patient better. All of this has made it safer for the patient.
One of the big impacts with the nerve blocks has been with shoulder surgery. Shoulder surgery is very painful. The patients we had before the nerve blocks were crying in pain, and it took a lot of narcotics to get them relieved. Now, they come to the Recovery Room with little to no pain. It is so much better for the patients, and it makes our job a lot easier.
If I have surgery, I want a continuous peripheral nerve block!
Debbie Purvis, Recovery Room RN
Coffee Regional Medical Center
One of the major concerns for patients undergoing surgical procedures is post-operative pain. Nerve blocks and continuous peripheral nerve blocks are a great intervention to drastically decrease the amount of pain a patient will experience. I am a Post-Anesthesia Care Unit (PACU) Nurse, and pain management is a top priority in my area. In my experience, the patients who have undergone some type of regional anesthesia have better pain control. Most patients have little to no pain and require fewer narcotics. In turn, patients are less nauseated and more alert in the PACU and Ambulatory Surgery Unit setting. Nerve blocks have increased our patient’s satisfaction at our hospital and made their visit more enjoyable. I am excited for this advancement in pain management for our surgical patients.
Amy Whitley, RN, BSN
Coffee Regional Medical Center
As a nurse of 17 years with most of that time spent in PACU, I can tell you that Peripheral Nerve Blocks are wonderful! When I started in PACU about 15 years ago, many surgeries such as total joints and abdominal surgeries were extremely painful for the patients. They were also frustrating for the nurses because we could never alleviate their pain, and if we did, they would have so much narcotics on board that we had to worry about nausea, vomiting and respiratory depression.
Then I met Dr. Jones. He came in with all these “grand” ideas about pain blocks. I was skeptical at first, but willing to try anything. The first couple of patients I cared for with PNB’s were simply amazing! They were awake, comfortable, breathing well and most importantly HAPPY!
Dr. Jones is very experienced with PNB’s and loved teaching us about them–and trust me, nurses can be a difficult group to persuade–but he took his time and taught us what we needed to know. It didn’t take long and we were eager to learn all that we could about nerve blocks.
I feel that Peripheral Nerve Blocks are valuable tools to the patient and the medical staff. The patients have an easier recovery time, and nurses have time to do what matters most–CARE for the patient. Dr. Jones and the technology we now have available for pain control is just a blessing for all involved!
Tiana Akins R.N.
Regional Hospital of Jackson
I am a nurse. More importantly, I am an Orthopedic Nurse. This means I tug, pull, move, bend, lift, roll, and squat ALL DAY LONG. Not saying that other nurses won’t do any of these things at some point in the day, but for us ‘Ortho Girls’, it consumes us every day! Most of our patients have had a major surgery (on a major joint) or have, in some form or fashion, had a surgery that compromised their ability to move…..which is why we do so much of the above!
Our patients feel like we need to be present for just about every movement, which is completely understandable! That is one of the reasons that we are here, and we are happy to help our patients with these needs. However, with all of the routine work that we already do for our patients, we are busy, busy bees. Throw on top of this 4 to 5 different patients calling for pain medicine every 1-2 hours, along with all the additional assessments and the additional charting that we have to do once we give pain medicine, and it’s almost unbearable. Add to this the concern we have as we wonder if we have given enough pain medicine (…or too much). This was my life before Dr. Jones started the Continuous Peripheral Nerve Block Program.
When we first heard about the blocks, we thought, “In theory, that sounds amazing, but is it really going to work, and how much extra time and effort are we going to have to throw into maintaining these nerve blocks?” Lucky for us, there was little to NO maintenance, and they worked like a dream! I was no longer being paged repetitively for more and more pain medicines, which would always lead to nausea medicine or cleaning up a huge mess from patients getting sick! I was no longer having patients who were miserable from constipation (and trust me, enemas aren’t fun for either party). I wasn’t having patients so sedated that they were unable to do Physical Therapy (which would prolong their stay).
What I was seeing was absolutely AMAZING! I was watching patients walking the halls the SAME DAY of their surgery, and not only were they walking the halls, but they were smiling while doing so! People were killing their physical therapy goals, and a lot of the time, they were going home a day earlier! Our patients were…wait for it…COMFORTABLE!! Their families were HAPPIER!! Last, but not least, our lives and job were EASIER!!
I had a patient about 6 months ago who had a Total Knee Arthroplasty on both of her knees, one after the next. For her first knee surgery, she was able to get the continuous nerve block, but for the second knee surgery, she was not. I asked her to rate her experiences. She told me that there was no comparison. She said that it was “like comparing a diamond and a rock.” In addition, she said that had she known that the continuous nerve block wouldn’t have been offered on the second knee, she would have never had the surgery. Sorry that this is a bit of a read, but I could go on and on about the amazing possibilities there are with these Blocks! Thank you JJ for all you did with the Continuous Nerve Block Program! We love you!!!
Jessica Johnson, Orthopedics Nurse
Regional Hospital of Jackson, Jackson, Tennessee
COMMENTS from Nurses at Paris Regional Medical Center in Paris, Texas:
“Very knowledgeable about the topic! No questions left unanswered. Presenters were great and provided all information.”
Latrisha, Orthopedics RN
“Very energetic! Breaks down and explains the steps for a successful program.”
Kelly Merrit, RN Director of Orthopedic Floor & Nerve Block Program Coordinator
“Easy to understand. I like the videos that I can pause and restart. The consulting team was available at the beginning of shift and the end. I don’t know when they rest! They were very helpful.”
Sheila, Orthopedics RN
“Positive program to provide better care and improve pt satisfaction, as well as employee satisfaction. Dr Jones and Sara are very knowledgeable and passionate about this program. I feel this will be an excellent asset to our hospital.”
Kara Neathery, RN Director of Step Down Unit
“I provided care for an (elderly) patient post-operatively after (a major surgery). With the nerve block, (the patient) arrived to the floor awake, alert and able to eat as soon as he arrived. Within 2 hrs post-op, he was able to get out of bed and ambulate to the bathroom. He did not require any narcotics for pain control on my shift, and he rested well. I am excited for this advancement in pain management for our surgical patients!”
Sheila Evans, Orthopedics RN
“The patient is sitting up and talking. She is doing great!”
Bobbi, Orthopedics RN
“Informative, well prepared, and great follow up! If this is what’s to come, I am all for it!”
Kyle, Orthopedics Nurse
I love it! CPNB’s cuts down on the patient’s recovery time, and the use of narcotics. My patients love the nerve blocks because they feel good and have excellent pain control. Oh, and Dr. Jones is the bomb-diggity! Nerve blocks reduced the amount of pain medication which meant more time for me to care for my patients without running back for narcotics every two hours. Nerve blocks gave me, as a nurse, a better work experience; and more than that, my patients were happy during their hospital stay.
Lori Langston, Orthopedics Nurse
Regional Hospital of Jackson, Jackson, Tennessee
I came to Regional to work on the orthopedics floor, and I was so excited for this opportunity. I had not worked on the floor except during clinicals in nursing school. I had wanted to work at Regional Hospital of Jackson here since I graduated and was thrilled when I was hired in 2010. I did not know a lot about orthopedic surgeries and even less about depo-dur, a long-acting narcotic given as an epidural injection. I had never heard of depo-dur until I was in orientation and I watched Dr. Homberg inject the medication into a patient prior to surgery. He explained what it was and how it works and quoted me a statistic of around “50%-90%” of pain is controlled, but it depended on the patient, and it was unclear which patients would receive how much pain control until after surgery was completed. I thought it was neat to have the extra pain control, and didn’t think much more about it. I quickly changed my mind about depo-dur once we started caring for these patients on a regular basis. Patients were coming back from surgery unable to wake up, with low oxygen saturation, vomiting, itching, and some would have such severe respiratory depression that they were sent to ICU. These changes could happen suddenly, and it was a scary feeling especially for a “new” nurse.
One day, I saw this man in scrubs hanging around the desk talking. I had never seen before, so I attempted to read his name tag, however, it was turned the wrong way. Being somewhat forward, I walked up to him and said “Who are you”? Then I flipped his name tag around so I could see it. Luckily, he found this funny, introduced himself, and gave a very in depth speech about what he was doing here and his plans for this unit. What felt like forever, was probably only ten minutes. I just kept thinking, “He wants to do what?” What is a nerve block, and why do we need that? Did he really just say that every patient will have a pump with this medication? Doesn’t he know how long that will take to set up? This will never work.
I don’t like to admit that I am wrong ever, but in this case, I was WRONG! The nerve block program has been one of the best things in my opinion to be introduced to this hospital. Almost instantly, patients were no longer being sent to the unit because they were only breathing six times a minute, and I was no longer giving pain medication every hour, along with nausea medicine, and Benadryl for itching. I realized these nerve blocks have cut down on about 30 trips down to patients rooms. I was happy because I had time to chart, the patient was happy because the pain was non-exist, or very minimal, and even the family was happy (which is hard to accomplish!) because ‘Mom’ or ‘Dad’ was wide awake after surgery and feeling good. Patients were coming back from recovery room sitting up in the bed asking for food. At that point, I changed my mind. Dr Jones was not crazy. This idea is genius! I was on board with the nerve block program and have been ever since.
Sara Johnson, RN
Regional Hospital of Jackson, Jackson, Tennessee
As a PACU nurse, I think peripheral nerve blocks are about the best things ever. I love seeing patients wake up comfortable, without pain, not having to worry about giving too much pain medication and affecting their breathing. The patients seem to recover quicker and are able to move around sooner.
Dr. Jones really cares about his patients. It matters to him how they’re feeling. He checks on them immediately post-op, and follows up throughout the recovery process. He never hesitates to answer any question they may have. He has a strong desire to make surgery and recovery an easier and better experience for the patient.
From my experience, surgery is often unpleasant, but with Dr. Jones and the continuous peripheral nerve block program, it is much less painful and much less stressful.
Allison Adams, RN
PACU Nurse, Regional Hospital of Jackson
My name is Cary Jo Morgan,
I’m the C.N.A. (Certified Nursing Assistant) on the 4th floor at Regional Hospital of Jackson in Jackson, TN. The most common patient that we care for on the fourth floor are those that have just had Total Joint Replacement (Knees, Hips, Shoulders, etc), so I have my work cut out for me! I have been here since May 2012.
Among other things, my job entails caring for and assisting patients on a daily basis in their rooms (Baths, Beds, helping them to the bathroom, etc). When I first started at Regional, my normal duties were more difficult. It was hard to help my surgery patients get up due to them being so uncomfortable and in so much pain. But when the Nerve Block and Ropivacaine Pump (Ropivacaine is a local anesthetic. It works by blocking nerve impulses, which helps to numb the area so you feel less pain.) came into play/effect, not only did my job get easier, so did the patients healing process. Because the patients weren’t feeling as much pain, they could get up and move around easier, which helped me tremendously. I, personally, would like to thank Dr. Jones for not only helping the patients with pain control but also helping me get the
patient up and moving with less pain and side-effects from all the narcotics (Hydrocodone, Morphine, etc).
So with this being said, if I were to have to have surgery, I would get a nerve block and ROPIVACAINE pump because I, personally, do not want all the side-effects from the NARCOTICS.
Thank You for taking the time to read my personal experience with nerve blocks and ROPIVACAINE pumps and how they help me perform my job duties and help post-surgery patients all day to feel less pain as I am doing so.
Cary Jo Morgan C.N.A.
Regional Hospital of Jackson, Jackson, Tennessee
Having been a Registered Nurse for 21 years, I have dealt with patient’s pain issues on a daily basis for years. As each patient presented with a different diagnosis, there was always one common factor…pain. Finding a treatment regimen for pain management, whether it was acute or chronic, has always been a balancing act. Some patients cannot tolerate higher doses of pain medication while others require an increased dose of medication for pain relief.
My recent experience working on the Orthopedic Floor at Regional Hospital of Jackson has given me a new perspective to pain management in my role as a Nurse and also in the patient’s role in improvement of their pain control.
What is this? It’s known as the “PNC”, peripheral nerve catheter. A small catheter is placed by thee affected nerve of sensation (or nerve that involves the area of pain), and a “numbing medication” relieves the pain while leaving the motor function more intact so that the patient can move the area involved (i.e., knee, shoulder, hip, arm, etc.). The PNC has been used many times with abdominal surgeries and had significant pain control at Regional Hospital.
The patient requires less pain medication and less sedation, so they are able to be out of bed or participate in Physical Therapy sooner. The patients absolutely love it! Many have proclaimed,”It is a miracle!”, especially those who have had surgery in the past without the PNC.
However! From a personal perspective, I experienced this PNC as a patient myself! Recently, I had a surgical manipulation of my left shoulder in which I went home with my PNC attached to a small pump of numbing medicine. I was able to use this for the next 3-4 days for comfort and pain control with sleeping at night, activities of daily living and Physical Therapy. And I’m going to tell you it was great! Dr Jones, my Anesthesiologist, was just terrific with my instructions, maintenance and follow-up care of my PNC. He was so very kind and thorough! Thank you so much Dr Jones! You are awesome! I have since referred many patients to Dr Jones for the use of the PNC nerve catheter and will continue to recommend this new device in the use of pain management.
Appreciative Nurse and Patient,
Tracy D Alford, RN
Regional Hospital of Jackson
I am sorry it has taken so long for me to get this letter to you about the Femoral Nerve Catheters (FNC) and their success here with our patients. In the 30+ years I have been a nurse, this is the BEST new thing to come along that I have seen!! It really is!
One of the benefits was that not one of our FNC patients got a post-operative pneumonia because they were able to cough and deep breathe as soon as they got to the floor. The BIGGEST benefit was that all of the FNC patients used much less narcotics than our other post-op patients who chose not to use the FNC. Yet, they were able to do therapy and then get up again sooner than those who chose not to use them.
I will need to have both knees done in a year or two and will have a FNC when I have mine done, unless of course you come up with something better by then. I truly learned a great deal from you and enjoyed working with you. Best of luck!
Carolyn Zapf, RN
Regional Hospital of Jackson, Jackson, TN
Hello, my name is Kim, and I have been a nurse for twelve years. The first six I worked in the ICU, and the last six years I have worked in the Recovery Room. The most important skills that a nurse will master in Recovery are airway and pain control.
In the hospital where I currently work, we do many types of surgeries. Perhaps the most painful surgeries performed are the orthopedic procedures. For many years, the anesthesiologists have tried to increase the patients comfort level post-operatively by performing what is called a nerve block. These single shot nerve blocks are most commonly given to patients who have some type of joint surgery. This type of block is easy for the nurse assisting the doctor and greatly benefits the patient post-operatively. But, the down side of the block is it only last for 12 to 16 hours. After the block has stopped working, the patient experiences a significant amount of pain, and they have to increase the intake of narcotics. For many people, especially the older population, this can add several complications to their post-operative period.
A few years ago, Dr. Jones introduced continuous peripheral nerve blocks to the PACU staff . My initial thought after the in-service was “this is never going to work”. My reasoning behind this was that we are way too busy and short-staffed to be trying to perform these complicated procedures. In the beginning, no one wanted to participate in assisting the doctors in placing these blocks. I would find myself avoiding any patient who would even be a potential candidate for a continuous nerve block. After several months of watching these block procedures, I started to see a big difference in post operative pain control as opposed to those who refused the block. As a nurse, it made my life so much easier. I have spent literally hours in the recovery rooms trying every drug available to decrease a patient’s post operative pain after an orthopedic surgery. Usually by the time you get there pain under control, they are so sedated you spend another 2 hours trying to get them awake enough to go out to the floor or possibly home.
Over the next six months, I observed two very important facts. First, the blocks were here to stay. If I was going to provide the best care to my patients, I had to start learning how to assist the physicians with the insertion of the blocks, and I had to truly understand the full benefit of them in order to answer any questions that my patients may have regarding them. So, my journey began. Every patient that was even a potential nerve block candidate, I wanted to start their case. It wasn’t long until I began to see the true benefit of the blocks. Patients were waking up much faster and requiring less pain meds and time in the PACU. When a patient would come into recovery that should have had a block and didn’t, we as nurses would get very upset and would be asking “Why did this patient not get a block?” These blocks save so much time, money, and suffering for our patients. I cannot tell you how nice it is for a huge shoulder surgery to come into PACU and leave within 30 minutes without ever giving a narcotic. IT’S A WONDERFUL FEELING for my patient and me as a nurse.
In October of 2010, my husband was involved in a car accident. He sustained several orthopedic injuries including an injury to his shoulder. When I was told that his injury would require surgery, the first words out of my mouth were “HE WILL GET A NERVE BLOCK!” It was the first time that I was on the opposite site of the fence. I finally got to see the other side of how the block works. My husband had very little pain in the immediate post-op period. I feel the block reduced many post-op complications that usually occur when the patient is forced to take narcotics to relieve postoperative pain.
Kim Hoots, RN
Methodist Medical Center of Oak Ridge, TN
I have been a registered nurse at the Methodist Medical Center of Oak Ridge (Tennessee) for more than 30 years. Over these years, I have seen many improvements in medicine. One area is how we manage pain. Now referred to as the “fifth vital sign”, pain is something we assess as often as we measure blood pressure or count a pulse. Pain management matters to my patients, and it matters to me.
It’s understood that patients will experience some level of pain after surgery, and how that pain is managed makes a huge difference in the outcome of their surgery. For many years, I have administered analgesic medication through an IV, IM or oral route, providing temporary pain relief. It’s difficult to witness a patient having to wait to receive another dose of pain medicine because the effect wears off before time to administer another dose. I don’t want them to have unnecessary pain, but I also don’t want them to experience some of the side effects of continuous narcotic use including: confusion, constipation, decreased respiratory effort, inactivity, and an increased potential for falling. I want them to get better and not experience a setback.
I currently work in the Same Day Services department, providing post-operative care to patients, and preparing them for discharge. A little over a year ago, I was introduced to something that revolutionized the way we help patients manage their post-op pain by using the ON-Q Pump. I have seen this device used on patients who’ve had surgery on their shoulders, knees and feet, going home with their own ON-Q Pump. Although it takes a few minutes to explain the pump to the patient and their family, it’s worth the time and effort to be able to send a patient home relatively pain free, knowing they are going to enjoy this level of comfort for the next 50+ hours. As a nurse, it also gives me comfort knowing they are going to have a reduced rate of developing side effects associated with frequent administration of narcotic analgesia. Patients going home with this new technology appreciate the printed material we send with them explaining the ON-Q Pump, and are comforted knowing they will receive a call from the anesthesia staff every day until their pump has been discontinued.
I’m not only a hospital nurse; I’m the primary caregiver for my 89-year-old mother-in-law, Virginia. Eleven months ago, I had an opportunity to experience the ON-Q Pump on a more personal level when she received one following a reverse total shoulder replacement. Virginia has a history of chronic constipation as well as sometimes being unsteady on her feet, placing her at risk for falls. I was relieved to know that with the pump, the possibility of worsening these problems was minimal. She responded very well to the pain relief provided by the ON-Q Pump and soon was able to begin physical therapy in her post-operative phase.
I am very grateful to Dr. Jerry Jones for initiating the ON-Q Pump program at Methodist Medical Center of Oak Ridge. What a blessing to be able to provide this valuable technology to the community we serve. I look forward to seeing this program not only continue, but grow as more and more patients benefit from receiving an ON-Q Pump.
Leigh Ann Kiraly, RN, BS
April 18, 2011