Introduction: Patients undergoing submuscular augmentation mammaplasty experience significant postoperative pain and discomfort. The use of narcotics and muscle relaxants has not offered complete relief. In response to this we conducted an initial trial of 200 patients over a 5-year period treated with periodic instillations of Sensorcaine through indwelling catheters placed in the subpectoral pocket. We determined that local anesthetics delivered in this manner are both safe and effective. This follow up study was performed to compare continuous infusion with an elastomeric pump to intermittent bolus instillation.

Methods: Forty patients undergoing augmentation mammaplasty serving as their own control,were randomized (alternating side to side) to receive Sensorcaine via self-administration through a syringe device to one breast and the ON~Q continuous infusion pump to the other. Pain scales, source of pain, analgesic and muscle relaxant use, and patient preferences were collected over a 7-day follow up period.

Results: Twenty five percent (25%) of the patients took no narcotics after their release from the recovery room. Pain score measurements for the first 3 days postop were lower in the continuous group vs. the intermittent bolus group but did not reach statistical significance. Patient preference for the continuous infusion device was significantly higher than the intermittent bolus device p<0.001. There were no complications associated with either device.

Conclusions: The infusion of a local anesthetic into the pectoral pocket for 24-48 hours following augmentation mammaplasty is effective in diminishing postoperative pain. This infusion, when used as part of a multimodal pain management program appears to result in a decrease in the length of the pain cycle and the use of narcotics for pain control.
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