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

Abstract

Objective: We evaluated the efficacy of a temporarily placed porous catheter with continuous application of a local anaesthetic (ON~Q® by I-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: 38.4 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.

Zusammenfassung

Fragestellung: Wir untersuchten die Wirkung eines zeitlich befristet platzierten, porösen Katheters mit kontinuierlicher Applikation eines Lokalanästhetikums (ON~Q® Pain Management System von I-Flow-Corp., Lake Forest, CA, USA) nach Mastektomie im Vergleich zu einer Kontrollgruppe ohne Katheter bezüglich des postoperativen Bedarfes an Opioid-Schmerzmedikation.
Material und Methode: Am Fayette Medical Center in Alabama wurde eine retrospektive Untersuchung aller konsekutiver Mastektomien (n =49) innerhalb eines 5-Jahres-Zeitraumes von Januar 1997 bis Dezember 2001 mit statistischer Analyse des Opioid- Schmerzmittelverbrauches durchgeführt und die beiden Gruppen: 1. ON~Q Pain Management Pump Gruppe mit kontinuierlicher 0,25 % Sensorcaine® (Bupivacain und Epinephrin) Applikation über ca. 72 h (n=22) mit 2. der Kontrollgruppe ohne Schmerzmittelpumpe (n=27) verglichen.
Ergebnisse: Beide Gruppen wiesen bezüglich der Patientendaten keine statistisch signifikanten Unterschiede auf. In der ON~Q-Gruppe benötigten weniger Patienten postoperativ keine Opioide: 18,2 zu 3,7 % (P=0,1), hatten keinen Opioidbedarf nach dem 1. postoperativen Tag: 68,2 zu 11,1 % (p < 0,001). Der gesamte Opioidverbrauch in Dosisequivalenten (DE) war in der ON~Q Gruppe reduziert: 1,25 zu 3,36 DE (-62,8 %) (p=0,016), wie auch der Opioidverbrauch am 1. postoperativen Tag: 0,65 zu 1,82 DE (- 64,6 %) (p=0,016) und 2. postoperativen Tag: 0,24 zu 0,75 DE (-68,4 %) (p= 0,011). Die Länge des Krankenhausaufenthaltes betrug 2,35 zu 2,93 Tagen (n. s.) und die Dauer der postoperativen Überwachung 38,4 zu 43,3 min (n. s.). Die OP-Zeit zur Applikation der ON~Q-Schmerzpumpe war nur geringfügig verlängert; es gab keine Komplikationen in der Anwendung.
Schlussfolgerung: Die Verwendung des ON~Q Pain Management Systems kann den postoperativen Bedarf von Opiaten zur Analgesie nach Mastektomie signifikant reduzieren oder sogar vermeiden.

Mastectomy - postoperative pain - pain management - breast cancer - local anaesthesia pump

Mastektomie - postoperativer Schmerz - Schmerztherapie - Brustkrebs - Lokalanästhetikapumpe

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