ON-Q
Anesthetic Pump
ON-Q anesthetic pump in gynecologic
oncology: feasibility study of a novel placement technique at an army hospital.
Naval
OBJECTIVES: The goals were (1) to describe a novel
placement technique for the ON-Q anesthetic system based on somatic neural
anatomy and (2) to determine its feasibility, efficacy, and associated
morbidity among surgical patients on a gynecologic oncology service. METHODS: A
retrospective observational study of 100 consecutive patients who underwent a
vertical laparotomy and received an ON-Q system was
performed. The ON-Q system was composed of a soaker catheter (threaded
longitudinally within the rectus sheaths) and an elastomer
pump that infused 0.5% bupivacaine at 2 mL/hour for up to 5 days. RESULTS: The average duration of
ON-Q system use was 4.4 days (range, 2-5 days). The median numeric pain scores
(range, 0-10) were 3, 2, 1, 0, and 0 on postoperative days 1, 2, 3, 4, and 5,
respectively. Complications encountered included suturing of the catheter to
the fascia (n = 1), wound hematomas (n = 2), and device failure (n = 1).
CONCLUSIONS: Intrafascial placement of the ON-Q
soaker catheter for bupivacaine infusion appears
effective for incisional analgesia, with negligible
wound morbidity and device failure rates.
Obes
Surg. 2008 Jul 22. [Epub ahead of print]
Links
Continuous Infusion of Intraperitoneal Bupivacaine after
Laparoscopic Surgery: A Randomized Controlled Trial.
Sherwinter DA, Ghaznavi AM, Spinner
D, Savel RH, Macura JM, Adler
H.
Department of Minimally Invasive Surgery,
BACKGROUND: A standard approach for postoperative
analgesia in laparoscopic surgery is to infiltrate the incisions with local
anesthetic in combination with systemic opioids. The intraperitoneal introduction of local anesthetic in this
setting has the potential to provide appropriate analgesia without the side
effects of systemic opioids. We performed a
randomized clinical trial of the On-Q pump delivery system to determine the
safety and efficacy of this device for this novel purpose. METHODS: Thirty
patients undergoing laparoscopic adjustable gastric banding were randomly
assigned to one of two groups. The treatment group received On-Q pump systems
filled with 0.375% bupivacaine, while the control
group received pumps filled with 0.9% normal saline. The pump's catheter was
introduced intraperitoneally, and bupivacaine
or saline was then delivered for the first 48 h after surgery. Patient's
subjective pain scores were evaluated at preset intervals. In addition,
shoulder pain, morphine requirements, and anti-emetic requirements were
tabulated. RESULTS: A statistically significant decrease in patient's
subjective reports of pain by visual analog score was noted in the On-Q group
1.8 +/- 1.93 vs. control 3.5 +/- 2.4, p < 0.046 and remained significant
until the end of the study (48 h). No statistical difference was noted in
shoulder pain, morphine requirements, or anti-emetic requirements at any time
point. CONCLUSION: Our trial was able to provide evidence of significant
reduction in postoperative pain as measured by subjective pain scores with the use
of continuous intraperitoneal bupivacaine
using the On-Q pain pump system. Further investigation is warranted to evaluate
the cost effectiveness of this technique.
Postoperative
continuous paravertebral anesthetic infusion for pain
control in lumbar spinal fusion surgery.
Department of Neurosurgery,
STUDY DESIGN: A retrospective, case-control study was
conducted to analyze postoperative outcomes in patients who received local anesthetic
infusion pumps after lumbar spinal fusion procedures. Data were collected
prospectively via nursing protocol and third party assessment, and analyzed
retrospectively. OBJECTIVE: To review the safety and efficacy of continuous
infusion of local anesthetic into the subfascial
aspects of the wound after lumbar fusion surgery for treatment of postoperative
pain, and to determine whether other outcome measures such as postoperative
nausea and vomiting, ambulation and length of hospitalization were affected by
the presence of the device. SUMMARY OF BACKGROUND DATA: Patients who undergo
lumbar spine fusion procedures frequently experience significant, debilitating
pain related to their surgery. This pain may delay postoperative mobilization,
increase length of hospitalization, and require prolonged use of high doses of
narcotics. Use of a local anesthetic continuous-infusion pump after surgery may
lead to improvements in these outcome variables. METHODS: After posterior
lumbar spine fusion procedures, 26 consecutive patients received the ON-Q PainBuster, which infused 0.5% marcaine
via an elastomeric pump into the subfascial aspects
of the wound. Retrospective analysis compared each of these patients with a
case-matched control patient. Data included pain scores and opiate use during
the first 5 postoperative days (PODs), length of
hospital stay, and complications. Variables such as age, American Society of
Anesthesiologists (ASA) physical status, and surgical procedure were similar
between matched cases. One patient was excluded because of active heroine
abuse. RESULTS: Patients with the ON-Q PainBuster
used 41.2% less narcotics on POD 1, 50.1% less on day 2, and 47.1% less on day
3 compared with the control patients. Differences in opiate usage were not statistically
significant on POD 4 (45.5% less) and 5 (50.3% less). A lower average pain
score was observed among patients with the ON-Q PainBuster
on each POD: 39.1% less pain on POD 1, 34.0% on day 2, 45.1% on day 3, 29.5% on
day 4, and 43.6% on day 5. No differences were observed in length of hospital
stay or complication rate. CONCLUSION: Patients who received the ON-Q PainBuster used less narcotic medications than case-matched
patients during the first 3 PODs, and reported lower
pain scores during the first 5 PODs. No complications
attributable to the device were noted. These results suggest that continuous
infusion of local anesthetic into the wound during the immediate postoperative
period is a safe and effective technique that results in lower pain scores and
narcotic use. Further data may reveal additional benefits such as lower
incidence of nausea and vomiting and decreased times to mobility and functional
independence.
Otolaryngol Head Neck Surg. 2008 Jan;138(1):110-2.
Links
Use of the ON-Q
pain pump
management system in the head and neck: preliminary report.
Department of Otolaryngology and Bronchoesophagology,
Management of postoperative pain can be critical to the
success of a patient's recovery following head and neck surgery. Various medications
and delivery methods have been described. They attempt to maximize patients'
comfort while minimizing many of the medications' potential side effects.
Continuous wound perfusion pain management systems are being used in various
surgical specialties. However, this is the first paper to describe the use of
one such pain management system (On-Q) in thyroid and parotid surgeries.
Statistically significant less levels of pain, use of opioids
and nausea/vomiting were noted in patients who used the On-Q system. There were
no complications. Use of continuous wound perfusion management systems should
be further investigated and highly considered in patients undergoing various
head and neck procedures.
Obes
Surg. 2007 May;17(5):595-600.
Erratum in:
Obes Surg. 2007 Jul;17(7):996.
A randomized trial of bupivicaine pain pumps to eliminate the need for patient
controlled analgesia pumps in primary laparoscopic Roux-en-Y gastric bypass.
Cottam DR, Fisher
B, Atkinson
J, Link
D, Volk
P, Friesen
C, Link
D, Grace
B, Trovar R.
Surgical
BACKGROUND: The use of a bupivicaine
pain pump has previously been reported to lower costs to hospitals, while
providing similar pain relief to opioid-based patient
controlled analgesia (PCA) pumps. However, these benefits have not been
investigated in laparoscopic bariatric surgery. METHODS: We prospectively
randomized 40 laparoscopic Roux-en-Y gastric bypass (LRYGBP) patients into two
groups. The first group received the ON-Q bupivicaine
pain pump placed subxiphoid and radiating in both
directions caudally beneath the lowest rib. The second group was treated with a
meperidine PCA, which was initiated in the PACU and
discontinued at 06:00 hrs the following morning. Both groups had identical
surgery, anesthesiologists, anesthesia protocol and postoperative nausea
prophylaxis. RESULTS: There were no significant differences between the groups
with regard to age, sex, pain scores, nausea scores, gas pain scores,
antiemetic use throughout their stay, or opioid use
in the PACU. However, there was a dramatic decrease in opioid
use between the two groups over the time interval from leaving the PACU to
06:00 hrs (meperidine by PCA mean 217 mg vs ON-Q 129 mg meperidine
equivalents, P=0.008). CONCLUSIONS: The use of a bupivicaine
pain pump offers the opportunity to dramatically reduce the use of opioids postoperatively in all bariatric patients by eliminating
PCA. This change could potentially reduce the incidence of respiratory failure
from oversedation, while offering the same levels of
pain control.
Clin Exp Obstet Gynecol.
2006;33(4):223-5.
Postoperative analgesia after
cesarean section by continued administration of levobupivacaine
with the On-Q Painbuster system over the fascia vs ketorolac + morphine i.v.
Magnani E, Corosu R, Mancino P, Borgia
ML.
Department of Gynecology,
OBJECTIVE: This study aimed to detect if continuous local
infusion of levobupivacaine with the On-Q Painbuster system provided postoperative analgesia of
similar quality to morphine + ketorolac i.v. in patients undergoing cesarean section. MATERIALS AND
METHODS: Using a randomized prospective double-blind study, 20 women undergoing
cesarean section with a standardized spinal technique were randomly assigned
into two groups to receive either 10 mg morphine + 120 mg ketorolac
+ saline solution up to 96 ml with an elastomeric pump i.v.
(group A) or local infusion of levobupivacaine 0.2%
with the On-Q PAINBUSTER system (group B). Both groups were administered ketorolac i.v. in bolus in case
of pain. RESULTS: The two groups differed in their VAS scores with group A
experiencing significantly less pain than group B; the consumption of
analgesics was significantly lower in group A than in group B. CONCLUSIONS: The
i.v. system with morphine and ketorolac
is more effective than levobupivacaine subcutaneous
infusion in reducing postoperative pain associated with cesarean section.
J
Thorac Cardiovasc Surg.
2005 Aug;130(2):464-8.
Improved pain
management outcomes with continuous infusion of a local anesthetic after thoracotomy.
Wheatley
GH 3rd, Rosenbaum
DH, Paul
MC, Dine
AP, Wait
MA, Meyer
DM, Jessen ME, Ring
WS, DiMaio JM.
Department of Cardiovascular and
Thoracic Surgery,
OBJECTIVE: We sought to determine the effectiveness of an incisional infusion of local anesthetics through a
continuous-infusion elastomeric pump for the management of postoperative pain
after thoracotomy. METHODS: We performed a
retrospective comparative analysis of 110 patients undergoing thoracotomies between November 1999 and March 2003.
Postoperative pain management with a continuous-infusion elastomeric pump
providing local anesthetic into the incisional area
was compared with a single-shot epidural in combination with continuous local
anesthetic infusion and continuous thoracic epidural infusion. Data sources
were reviewed for mean narcotic use, pain score, and complications. RESULTS:
After thoracotomy procedures, 38 patients received
the ON-Q Pain Relief System (I-Flow Corp,
Am Surg.
2004 Nov;70(11):1002-6.
Local anesthetic infusion pumps
improve postoperative pain after inguinal hernia repair: a randomized trial.
Sanchez
B, Waxman
K, Tatevossian R, Gamberdella M, Read
B.
Department of Surgery,
Pain after an open inguinal hernia repair may be
significant. In fact, some surgeons feel that the pain after open repair
justifies a laparoscopic approach. The purpose of this study was to determine
if the use of local anesthetic infusion pumps would reduce postoperative pain
after open inguinal hernia repair. We performed a prospective, double-blind
randomized study of 45 open plug and patch inguinal hernia repairs. Patients
were randomized to receive either 0.25 per cent bupivicaine
or saline solution via an elastomeric infusion pump (ON-Q) for 48 hours, at 2 cc/h. The catheters were placed in the subcutaneous
tissue and removed on postoperative day 3. Both groups were prescribed hydrocodone to use in the postoperative period at the
prescribed dosage as needed for pain. Interviews were conducted on
postoperative days 3 and 7, and patient's questionnaires, including pain
scores, amount of pain medicine used, and any complications, were collected
accordingly. During the first 5 postoperative days, postoperative pain was
assessed using a visual analog scale. Twenty-three repairs were randomized to
the bupivicaine group and 22 repairs randomized to
the placebo group. In the bupivicaine group, there
was a significant decrease in postoperative pain on postoperative days 2
through 5 with P values <0.05. This significant difference continued through
postoperative day 5, 2 days after the infusion pumps were removed. Patients who
had bupivicaine instilled in their infusion pump had
statistically significant lower subjective pain scores on postoperative days 2
through 5. This significant difference continued even after the infusion pumps
were removed. Local anesthetic infusion pumps significantly decreased the
amount of early postoperative pain. Pain relief persisted for 2 days after
catheter and pump removal.
Zentralbl Gynakol.
2003 Jan;125(1):17-22.
Reduction or
elimination of postoperative pain medication after mastectomy through use of a
temporarily placed local anesthetic pump vs. control group.
OBJECTIVE: We evaluated the efficacy of a temporarily
placed porous catheter with continuous application of a local anaesthetic(ON-Q(
by l-Flow-Corp.,
Dig Surg.
2003;20(4):285-9. Epub 2003
May 15.
Randomized
clinical trial of postoperative subfascial infusion
with bupivacaine following ambulatory open mesh
repair of inguinal hernia.
Department of Surgery, University
of Hong Kong Medical Center, Tung Wah Hospital, Hong
Kong, China. lauh@hkucc.hku.hk
BACKGROUND: Wound pain remains the commonest problem after
ambulatory open repair of inguinal hernia. Postoperative subfascial
infusion of the wound with bupivacaine extends local
analgesia at home and may achieve superior analgesia compared with oral
analgesics alone. The objective of the present trial was to evaluate the
efficacy of postoperative subfascial infusion of the
wound with 0.5% bupicavaine at 2 ml per hour for 48 h
after operation. METHODS: Forty-four patients who underwent ambulatory open
tension-free mesh hernioplasties were randomized to
two arms of treatment. The pump group had an infusion pump containing 100 ml
0.5% bupivacaine being placed between the external
oblique aponeurosis and the Prolene
mesh, whereas the nonpump group was treated with oral
analgesics alone. Assuming that an observed difference of 2.0 existed between
the mean pain scores of the two groups, the estimated sample size would be at
least 20 patients in each group. RESULTS: Postoperative pain scores at rest and
on coughing were significantly lower in the pump group than in the nonpump group on days 0 and 1 after surgery (p < 0.01).
Before being discharged, none of the pump group patients requested analgesics,
but 6 patients of the nonpump group required
analgesic supplement (p = 0.025). Ten patients (50%) of the pump group
experienced no pain during the period of bupivacaine
infusion. Recovery variables, including time taken to resume ambulation and micturition, were comparable between the two groups. The
pump and nonpump group patients returned to their
normal activities after a median of 3 and 4 days, respectively (p = 0.217). The
postoperative morbidity rates of the two groups were similar. CONCLUSION:
Postoperative subfascial infusion of the wound with
0.5% bupivacaine achieved superior analgesia compared
with oral analgesics alone. Portable infusion pump is a safe technique to
continue local analgesia at home after ambulatory open repair of inguinal
hernia. The drawbacks of the ON-Q Pain Management System included its high cost
and frequent seepage of blood-stained anesthetic fluid into the wound dressing.
Copyright 2003 S. Karger AG,
J
Am Assoc Gynecol Laparosc.
2000 Nov;7(4):552-5.
On-Q system for
managing trocar site pain after operative
laparoscopy.
Stringer
NH, Rodino KL, Edwards
M, Kumari NV.
55 East Washington,
The On-Q system provides long-term pain relief with
continuous infusion of a local anesthetic directly into the trocar
site after operative laparoscopy. An elastometric
pump filled with bupivacaine HCl
and a catheter, inserted by the surgeon, delivers 48 hours of anesthesia (100
ml) at a rate of 2 ml/hour. The pump is secured to the outer surgical dressing
or to the patient's clothing with tape or an E clip provided in the package.
The system can be removed by the patient when the infusion is complete.
ญญญญญญญญญญญญญญ