Efficacy of the Pain Pump Catheter in Immediate Autologous Breast Reconstruction

Abstract

The purpose of the investigation was to evaluate the efficacy of a slow bupivacaine infusion at postoperative surgical sites in immediate breast reconstruction patients. This prospective study included 16 patients who underwent autologous breast reconstruction with a latissimus dorsi pedicled flap immediately after mastectomy. A two-site infusion kit with dual split-flow catheters was secured at the operative sites before skin closure. A spring-loaded disposable pump then infused 0.25% bupivacaine at a rate of 2.08 cc per catheter per hour for 48 continuous hours. Patient pain levels, nausea/emesis, and oral and intravenous narcotic use were then recorded at 12-hour intervals. Medication use was converted to pain units for results comparison (one pain unit was defined as the equivalent of 10 mg of intravenous morphine). A retrospective control group comprised 16 consecutive patients from December of 1999 to October of 2002 who underwent the same surgery by the same surgeon using oral and intravenous pain medications. The experimental group demonstrated a more than fivefold decrease in the use of oral and intravenous pain medications compared with the historical controls (6.7 versus 1.7 pain units) (p < 0.001). The overall pain experienced by the catheter patients was nearly twofold less than the pain experienced by those without the catheter (1.8 versus 3.4 on the visual analog pain scale) (p < 0.017). Twenty-eight percent of the experimental group experienced nausea/emesis compared with 61 percent in the control group. No complications occurred with the use of the pain pump catheter. A 48-hour infusion of 0.25% bupivacaine significantly decreases the need for postoperative narcotics and the over-all pain experience in immediate breast reconstruction patients. This effective form of pain control may alleviate patient concerns of postoperative pain and may safely downstage many plastic surgery procedures, such as immediate breast reconstruction, and many cosmetic procedures to same-day status when the primary indication for admission is pain management.

Issues related to choice of breast reconstruction in early-stage breast cancer

“…In addition, patients who require radiation therapy will avoid the potential radiation-induced problems that are known to occur with immediate reconstructions [23••]. • Continuous infusion pain pumps used postoperatively for up to 72 hours have been shown to dramatically affect pain ratings, along with significantly decreasing oral and intravenous narcotic usage in patients after autologous reconstructions [57] and tissue/expander reconstructions [58••]. The pump is portable, disposable, and pressure driven to deliver 0.25% bupivacaine through small catheters into the operative sites.…”

Cost-Effectiveness Analysis of Levobupivacaine 0.5 %, a Local Anesthetic, Infusion in the Surgical Wound After Modified Radical Mastectomy

“…Regarding infusion pumps at the surgical site, Baroody et al [6] assessed their costs and efficacy in breast reconstruction, estimating that the added costs of the catheter and additional medication were US$280 per 48 h, while the costs of intravenous analgesic drugs were US$65 to 150; nevertheless, its use, given the efficacy of the technique, was recommended.…”

“…In particular, the delivery of drugs by continuous infusion through catheters [3,4] has been used in both simple and modified mastectomies [5,6], as well as in a wide range of other types of surgeries [7][8][9][10][11][12][13], and recently in modified radical mastectomy [14] in a double-blind, placebo-controlled, parallel-group randomized clinical trial.…”

A review of pain pumps in plastic surgery

“…The study found that patients were more comfortable and used less narcotics. Baroody et al (5), in a study of 16 prospective, immediate, autologous latissimus dorsi breast reconstruction with historical controls, showed that continuous infusion of bupivacaine decreased pain and narcotic use significantly in the postoperative period. They also observed that there was a reduction in PONV.…”

“…Pain pumps using continuous infusions of local anesthetic agents have been studied in various types of surgical procedures (1,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). They are placed in the surgical site and local anesthetics are delivered to the site.…”