Mythbusting the Painbuster: Part 2

I have discussed the use, and the marketing of Painbuster before. It is plausible and at least one trial of its use after abdominal surgery when placed in the preperitoneal plane indicated benefit. There is little evidence of its benefit after caesarean section but that didn't stop the rep getting to my OB yesterday and getting him to place a PainBuster in the preperitoneal space loading it with 20 ml of 0.5% ropivacaine and infusing the same at 5 ml an hour. To my chagrin the patient, a medically qualified mother of now four cesarean babies said it was the best recovery ever: little pain, no nausea, had a shower, taken calls etc,etc. She said the most painful part of the wound was near the catheter insertion site which was presumably distant from the holes that the LA was leeching from.
She had other multimodal analgesia: 50 ug intrathecal morphine, paracoxib and paracetamol, and given her history of PONV, multimodal antiemesis too.
Her special extra treatment would cost approximately $500 of equipment and drugs. How many poor QoRs would we save by making it a routine? The few "willingness to pay" studies on analgesia and antiemesis indicate that the the community would be prepared to pay $50 each for analgesic and an antiemetic that works. If it takes 5 to 10 cases of Painbuster in addition to standard multimodal analgesia to save a case from a poor QoR that could be a bill of up to $5000 to save a case of poor QoR. That becomes a serious value judgement.