Presentation presented to begin the process of establishing my product as a regular option for post-operative pain management.

1. University of Kentucky Medical Center Evaluation Meeting June 2, 2005

11. Cross-section of the pump

13. Diagram of Y-Site Design

15. What does “Soaker” mean?

20. Catheter Placements

21. Nursing Quick Reference Guides

22. Patient Brochures

23. Economics

24. Length of Stay Reduction 1.3 Breast Recon Spann .5 Iliac Crest Walker .5 Mastectomy Jacobs/Morrison 1 Colorectal Thorson 1 Hand assist Nephrectomy Patel 1-3 CABG Dowling 1 Foot and Ankle 1.5 CABG White 2 Abd. Hysterectomy Zimberg LOS Savings (days) Procedure Investigator

26. PCA Economics $600+ Total 3 day cost ? Narcotic Complications $100+ PONV Meds $50 Nursing Labor to maintain $50-200/2days Pharmacy Fill of Narcotic Bag $10/day Flushing supplies $10-60 IV catheter and tray $3-5 Admin Set $20-50/day Pump Costs Description

27. Costs Associated with Ileus Reduction

28. Actual Costs for One Hospital $3,005 10.59 $31,821 AAA $1,424 5.00 $7,124 Thoracotomy $1,548 13.63 $21,101 Colectomy $2,720 7.59 $20,646 CABG $1,929 3.73 $7,187 TAH $3,765 4.34 $16,326 Total Hip Average Cost/Day Average LOS Average Total Cost Procedure

29. Projected Savings With ON-Q *Assumes last day is only 25% of Average Cost/Day **Assumes ON-Q costs $300 and a 1 day LOS reduction $241,000 Total $8,000 $6,000 $4,000 $53,000 $29,000 $141,000 Annualized Savings $3,005 $1,424 $1,548 $2,720 $1,929 $3,765 Average Cost/Day $451 $751 AAA $56 $356 Thoracotomy $87 $387 Colectomy $380 $680 CABG $182 $482 TAH $641 $941 Total Hip Savings with ON-Q ** 25% Last Day Cost * Procedure

30. Projected Savings With ON-Q *Assumes last day is only 25% of Average Cost/Day **Assumes ON-Q costs $300 and a 1 day LOS reduction $241,000 Total $8,000 $6,000 $4,000 $53,000 $29,000 $141,000 Annualized Savings $3,005 $1,424 $1,548 $2,720 $1,929 $3,765 Average Cost/Day $451 $751 AAA $56 $356 Thoracotomy $87 $387 Colectomy $380 $680 CABG $182 $482 TAH $641 $941 Total Hip Savings with ON-Q ** 25% Last Day Cost * Procedure

32. Higher Patient Volumes: Example TAH Hypothetical example using LOS savings only. Additional profitability can come from reduced medications and complication treatments $37,810 $7005/case $266,190 $304,000 38 2.73 ON-Q +$161,040 +$13,420 -$182/case $50,580 +$64,000 8 1 Difference Annual Profit Gain $24,390 Monthly Profit $7187/case $215,610 Costs per Case per Month $240,000 Revenue ($8,000/case) 30 Monthly Patient Volume 3.73 LOS days PCA

35. Total Billed Charges Capitation fixed negotiated rate paid per member per month for health care services Case Rate flat negotiated rate for a defined procedure & length of stay Per Diem flat negotiated daily rate defined by level of care Discounted Fee for Service % of total gross charges PPO Indemnity POS/EPO HMO % of All Payments <5% <10% Approx.30% Approx.30% Approx.30% The hospital will generate a bill for all charges for all services during a patient’s entire confinement, including ON-Q. Whether they will receive payment for billed charges for ON-Q will depend upon the particular payment arrangements in place with the particular payor .

42. Pumps either come with a Clip or Fanny Pack

44. Clinical Information

47. Klein Interscalene

48. Gottschalk – Shoulder ** ** ** ** ** **# ** ** **# Gottschalk A, Anesth Analg 2003; 97: 1086-91

49. VAS Values During Mobilization ** ** # ** ** ## ** ** # **p<0.005 vs. Gr. S; ## p<0.005, # p<0.05 vs. Gr. R2 Gottschalk A, Anesth Analg 2003; 97: 1086-91

50. Cumulative Narcotic Requirement ** * **p<0.005, *p<0.05 Gr. R2 and Gr. R3.75 vs. Gr. S

51. White, Open Heart 0.5% Bupivacaine 0.25% Bupivacaine Saline Postoperative Time (h) Postoperative Time (h) White P, Use of a Continuous Local Anesthetic Infusion for Pain Management after Median Sternotomy, Anesthesiology, V99, No. 4, Oct 2003

52. Patient Satisfaction % of patients satisfied with pain management Saline 0.5% Bupivacaine 0.25% Bupivacaine

53. 0 1 2 3 4 5 6 7 0 1 6 12 24 48 56 Blood Levels (  g/mL) Hours Postoperative Mean Postoperative Blood Levels Bupivacaine Lidocaine Ropivacaine Bupivacaine & Lidocaine Toxicity Level Ropivacaine Toxicity Level Pump out 2 cc/hr through single catheter

54. Washington County Total Joint Nausea Vomiting

55. Washington County Total Joint

56. Wound Infiltration after Knee-/Hip Arthroplasty Morphine/Ketorolac IV vs. Bolus Ropivacaine 0.5% 40ml+cont. Infusion Ropivacaine 0.2% 5 ml/h n=37 Bianconi M et al, Br J Anaesth 2003; 91: 830-5

57. Infection Rates ** National Nosocomial Infection Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004 Am J Incect Control 2004;32:470-85. Procedure Published Rate** % Rate with ON~Q Pump [i] % Number of Patients Mastectomy 1.74 0 44 Thoracotomy 2.47 0 69 CABG 2.19 0 111 C-Section 4.14 0 186 Hysterectomy 2.32 0 432 Bariatric 8.34 0 100 Inguinal Hernia 0.8 0.7 968 Colorectal 8.54 4.4 251 Prostatectomy 0.81 0 226 Nephrectomy 1.04 0 69 Orthopedic Surgery 1.48 0 328 General Surgery 4.02 0.69 2456 All Surgery 2.6 0.61 2784

60. Long Term Benefit

61. Lavand’homme et al C-Section Residual Pain % of Patients Having Pain

62. Schell, Breast Cancer Shoulder Pain and Disability Index Mean Follow-up: 2.4 ±0.01 years 0: No Difficulty 100: Requires Help SPADI Item p < 0.05 * p = ns * * * * *

63. Orthopedic Protocols

65. Subacromial Placement