ON-Q Anesthetic Pump


Mil Med. 2008 Sep;173(9):918-23. Links

ON-Q anesthetic pump in gynecologic oncology: feasibility study of a novel placement technique at an army hospital.

Shen-Gunther J.

Naval Medical Center San Diego, San Diego, CA 92134-6200, USA.

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]Click here to read 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, Maimonides Medical Center, Brooklyn, NY, USA, dnsherwinter@yahoo.com.

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.


Spine. 2008 Jan 15;33(2):210-8.Click here to read Links

Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery.

Elder JB, Hoh DJ, Wang MY.

Department of Neurosurgery, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA. jelder@usc.edu

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.Click here to read Links

Use of the ON-Q pain pump management system in the head and neck: preliminary report.

Charous S.

Department of Otolaryngology and Bronchoesophagology, Rush University Medical Center, Glenview, IL, USA. scharous@comcast.net

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. Links

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 Weight Control Center, Las Vegas, NV 89107, USA. drdanielcottam@yahoo.com

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. Links

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, University of Rome "La Sapienza", Rome, Italy.

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.Click here to read Links

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, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.

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, Lake Forest, Calif), 32 received the ON-Q device and single-shot epidural infusion, and 40 received continuous epidural infusion. Demographic attributes, including age, body mass index, and sex were similar between the groups. Preoperative American Society of Anesthesiologists status was significantly higher in the ON-Q group compared with that in the other groups (P = .02). Narcotic use and pain scores were significantly reduced in the ON-Q group compared with that in the epidural group at all time points (P < .001). There were no wound-healing complications or infections associated with the use of the pump. CONCLUSION: A continuous infusion of 0.25% bupivacaine at 4 mL/h through the ON-Q elastomeric infusion pump is a safe and effective adjunct in postoperative pain management after thoracotomy. The use of the ON-Q Pain Relief System results in decreased narcotic use and lower pain scores compared with continuous epidural infusion.


Am Surg. 2004 Nov;70(11):1002-6. Links

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, Santa Barbara Cottage Hospital, Santa Barbara, California 93102, USA.

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. Links

Reduction or elimination of postoperative pain medication after mastectomy through use of a temporarily placed local anesthetic pump vs. control group.

Morrison JE Jr, Jacobs VR.

OBJECTIVE: We evaluated the efficacy of a temporarily placed porous catheter with continuous application of a local anaesthetic(ON-Q( by l-Flow-Corp., Lake Forest, CA, USA) post mastectomy vs. patients without this device regarding postoperative need for opioid medication. MATERIAL AND METHODS: At Fayette Medical Center, Alabama, a retrospective evaluation of all consecutive mastectomies (n = 49) within a five-year-period from 1/1997-12/2001 and statistical analysis regarding postoperative need for opioids was performed. The ON-Q pain management pump with continuous 0.25% Sensorcaine (Bupivacaine and Epinephrine) application for about 72 h (n- 22) was compared vs. a control group without pain management pump (n- 27). RESULTS: There were no statistical significant differences regarding patient demographics in both groups. Patients in the ON-Q group with no need of postoperative opioid pain medication were: 18.2 vs. 3.7 % (P - 0.1), no need for opioids after postoperative day 1: 68.2% vs. 11.1 % (P 0.001), total opioids usage in dose equivalents (DE): 1.25 vs. 3.36 DE (-62.8%) (P-0.016), opioids usage postoperative day 1: 0.65 vs. 1.82 DE (-64.6%) (P - 0.016),opioids usage postoperative day 2: 0.24 vs. 0.75 DE (-68.4%)(P - 0.011). The length of stay in hospital was 2.35 vs. 2.93 days(n.s.), and postoperative stay in PACU: 384 vs. 43.3 min (n. s.).OR time for placement of catheter and pump is only slightly increased. No complications occurred. CONCLUSION: Use of an ON-Q pain management pump could significantly reduce or even eliminate postoperative need for opioids analgesics.


Dig Surg. 2003;20(4):285-9. Epub 2003 May 15.Click here to read Links

Randomized clinical trial of postoperative subfascial infusion with bupivacaine following ambulatory open mesh repair of inguinal hernia.

Lau H, Patil NG, Lee F.

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, Basel


J Am Assoc Gynecol Laparosc. 2000 Nov;7(4):552-5. Links

On-Q system for managing trocar site pain after operative laparoscopy.

Stringer NH, Rodino KL, Edwards M, Kumari NV.

55 East Washington, Suite 2043, Chicago, IL 60602, USA.

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.