Use of the Infusion Pain Pump Following Transverse Rectus Abdominis Muscle Flap Breast Reconstruction

Abstract

The infusion pain pump has been a valuable addition to postoperative pain management in plastic and reconstructive surgery. Concerns have been raised regarding the potential ischemic or infectious complications of placing a catheter beneath the operative site for infusion of local anesthesia (+/- epinephrine). The purpose of this review is to document our experience with this form of postoperative pain control in plastic surgical procedures. Thirty-six consecutive transverse rectus abdominis muscle (TRAM) flap breast reconstruction patients were reviewed and included in the series (16 left, 10 right, and 10 bilateral). The average age was 52 years, and 4 patients had a simultaneous symmetry procedure. The cohort was divided into those with a postoperative pain pump versus those without a pain pump. Data points queried included type, route, and amount of narcotic administered per day in the postoperative period, as well as complications. All patients received patient-controlled analgesia (PCA) (morphine, n = 34; meperidine (Demerol, Sanofi-Synthelabo), n = 1; hydromorphone hydrochloride (Dilaudid, Abbott Pharmaceutical) n = 1). The pain pump was used in 16 patients (bupivacaine (Marcaine, AstraZeneca, n = 16). It was typically infused starting postoperatively at a rate of 4 mL/d and discontinued on postoperative day 2. Supplemental intravenous narcotics were required in 12% (n = 2/16) of patients with a pain pump versus 35% (n = 7/20) in those patients without a pain pump. There were no significant differences in the average number of days the PCA was used (1.8 days with a pain pump versus 2.2 without), and patients with the pain pump started postoperative medications slightly earlier (1.8 versus 2.0 days). PCA requirements were significantly lower in those patients with the pain pump. The average days to discharge for patients with a pain pump were 3.4 compared with 4.7 days in those patients without the pain pump. There were no differences in donor-site or breast complications. The postoperative pain pump has been useful in reducing the intravenous narcotic requirements and length of stay in patients following TRAM flap breast reconstruction. There were no flap, donor-site, or implant complications related to the presence of the catheter. Cost-effectiveness and patient satisfaction data would be interesting.

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

“…Some authors [20,22] stated that it would be interesting to carry out a cost-effectiveness analysis of the infusion pump. Specifically, using the cost-effectiveness ratio we have obtained the ''cost'' of additional results achieved by changing the usual clinical practice to the Values are expressed as mean ± SD PONV postoperative nausea and vomiting, PACU post-anesthesia care unit Optimistic -20…”

“…On the other hand, authors of other studies on the infiltration of local anesthetics in breast reconstruction [22] have noted the need for research on cost-effectiveness and patient satisfaction.…”

“…A meta-analysis on the different studies examining the effectiveness of the administration of a local anesthetic suggests a potential saving of one day hospital stay [13], thereby saving the costs involved. In the studies on infusion of a local anesthetic in breast surgery, there is great variability in the length of hospital stay, ranging from 3 to 10 days [18][19][20][21][22].…”

Disposable Non-Mechanical Elastomeric Balloon Pump for Continuous Epidural Infusion: An Effective and Reliable Means for Postoperative Analgesia

“…(VAS 0 -VAS 3). [19,20] Motor Block was assessed by using the modified Bromage Scale (0 = No blockade; 1= Inability to raise extended leg; 2 = Inability to flex the knee; 3 = inability to move lower limb. In our study all the 30 (100%) patients had complete motor block (Bromage 3) at "0" hour i.e.…”

A review of pain pumps in plastic surgery

“…Losken et al (27) performed a case-control study on 32 transverse rectus abdominis myocutaneous flap breast reconstruction patients. They administered continuous bupivacaine into the abdominal incision for 48 h in 16 patients.…”