The Use of a Marcaine Pump for the Control of Postoperative Pain in Abdominal Reconstruction.
Henry Mentz III, M.D.,F.A.C.S., Amado Ruiz-Razura, M.D., F.A.C.S.
German Newall, M.D., F.A.C.S. and Christopher Patronella, M.D., F.A.C.S.
From the Aesthetic Center for Plastic Surgery. Houston, Texas. USA
PURPOSE:
This study presents the results of 20 patients undergoing an abdominal
wall reconstruction utilizing a pain relief system that provides continuous
infusion of a non narcotic medication (Marcaine) directly into the surgical
site for reducing 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 a non narcotic cocktail is administered via a thin
fenestration catheter inserted into the abdominal wall or placed directly
in top of the abdominal fascia. The pain relief system consists of a
balloon pump that can be programmed to offer continuous infusion rates
of 0.5,1, 2, 3, 4, 5, 6, 7, 8, 9, and 10 ml/hr. Bolus programming allows for
1, 2, 3, 4, and 5 ml. It provides a kinkless catheter which avoids problems
of occlusion. Bolus lockout times are 10, 20, 30, 45 ,60, 90 and 120 minutes.
Programming lockout eliminates possibility of patient manipulation of
settings and a digital display provides constant infusion status. It has
a sensor that sounds off in case of an occlusion . The device is simple
to program, completely enclosed and protected and can be worn with
a shoulder strap or in a fanny pack. Reservoirs of 250 cc and 400 cc
are available for administration of large volumes.
Ten additional patients received standard oral and intramuscular post
operative medications for pain ie: Demerol, Percocet, Lortab, and no use
of a PCA or pain pump. Patients were asked to complete an evaluation of
their post operative pain and discomfort.
RESULTS:
Our study reveals a significant reduction in postoperative pain
and discomfort obtained by the use of the pain pump. Although the group with the pain pump was older (38.2 vs 34.5), had more procedures (6.2 vs 4.8), and had stronger pain medicines (Class II and III vs. Class II) they still took far less post op narcotics (16.8 vs 37.5 pills), resumed normal activities sooner (day 2.5 vs day 7.5) and rated their recoveries as better (7.8 vs 7.0) than the non pain 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 and the strength of post operative pain medications make us feel very
optimistic that patients appreciate the use of this device.
CONCLUSION:
Although our initial results are very encouraging and suggest that the use of
a pain pump may justify the extra cost when performing abdominal wall
reconstruction cases, we feel that further research is mandatory with more
clinical cases in order to recommend the use of this device for pain
management after an abdominoplasty.
Picture No. 1- Stryker Pain Pump 2, a patient controlled
ambulatory delivery pain relief infusion system used in this
study.
Picture No. 2- Pump with a 250cc volume reservoir, 2.5” and
5.0” fenestration catheters, a standard catheter, introducer split
needle, tubing and 60 cc syringe ready to be installed on the
patient.
Picture No. 3- Placement of fenestration and standard infusion
catheters.
Picture No. 4- The tip of the catheter is placed in top of the fascia and
can be buried within a plication stitch.
Picture No. 5- The external portion of the catheter
is maintained in position with a conventional
dressing.
Picture No. 6- Pump is running according to surgeons specific
settings and ready to wear in a shoulder strap or in a padded
carrying case (fanny pack).
For additional information on this body contouring article, please contact:
Dr. Henry Mentz and the Aesthetic Center for Plastic Surgery
(713) 799-9999
mentz@compuserve.com
Source: Dr. Henry Mentz
http://www.drmentz.com
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