Confex
The Use of a Pump for the Control of Postoperative
Pain in Abdominal Reconstruction.
Henry A. Mentz, III, M.D., Amado Ruiz-Razura, M.D., German Newall, M.D. and Christopher K. Patronella, M.D.
From The Aesthetic Center for Plastic Surgery. Houston, Texas. USA
PURPOSE:
Present the results of 20 patients undergoing an abdominoplasty
utilizing a pain relief system that provides continuous infusion
of a non narcotic medication directly into the surgical wound
to reduce pain in the postoperative period.
MATERIALS AND METHODS:
Ten patients had a pain pump2 (Stryker Instruments Kalamazoo, MI)
which is a pain management device that offers the features of a PCA
pump while been disposable and for ambulatory use. This patient
control continuous delivery of bupivacaine (Marcaine) is administered via
a thin fenestrated catheter placed in the abdominal wall directly
in top of the fascia. The system consists of a balloon pump
that can be programmed to offer continuous infusion rates
from 0.5 to 10 ml/hr. It provides a kinkless catheter which
avoids problems of occlusion. Programming lockout times
eliminates the possibility of patient manipulation of settings and
a digital display provides constant infusion status. The device is
simple to program, completely enclosed and can be worn with
a shoulder strap or in a fanny pack.
Ten additional patients received standard post operative medications
for pain (ie: Demerol, Percocet, Lortab ) and no PCA or pain pump.
Patients were asked to answer an evaluation of their post
operative pain and discomfort.
RESULTS:
Our study reveals a reduction of postoperative pain by the use of the pump.
Results and parameters are presented in tables 1, 2 and 3.
[pic]
DISCUSSION
Although the group with the pain pump was older (38.2 years versus 34.5)
had more procedures (6.2 versus 4.8) and had weaker pain medicines
(classes II and III versus class II) they still took far fewer post operative
narcotics (16.8 versus 37.5), resumed normal activities sooner (day 2.5
versus day 7.5) and rated their recovery as better (7.8 versus 7.0) than
the non-pump group.
The ease of the technique to install and run the pump and the benefits obtained such as early ambulation, less pain, reduced need for other post operative pain medications and less side effects such as nausea, vomiting, post op delirium, urinary retention and ileus make us feel very optimistic.
CONCLUSION:
Although our initial results are very encouraging and suggest that the use of
a pain pump may justify the extra cost when performing an abdominoplasty,
we feel further research is necessary that involves more clinical cases
in order to recommend the use of this device for pain management after
abdominal reconstruction cases.
[pic]
Picture No. 1- Stryker Pain Pump 2, a patient controlled
pain relief infusion system used in this study.
[pic]
Picture No. 2- The tip of the catheter is placed in top of the
fascia or can be buried within a plication stitch.
[pic]
Picture No. 3- Pump in place and running according to
surgeon’s specific settings.
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