INTRODUCTION:Portable infusion pumps used for local anesthesia during continuous regional analgesia are gaining acceptance. However, there are very few reports on the use of these devices in Plastic Surgery.
PURPOSE: The purpose of this study was to investigate the use of pain pumps in a painful plastic surgery procedure. A comparative analysis was made to present the results of two groups of patients treated with and without an ambulatory pain relief system. Special attention is given to offer technical specifications of the delivery of medication with infusion pumps .
MATERIALS AND METHODS: Twenty five female patients with an average age of 42 , from a large group practice had an abdominoplasty . They all underwent central muscle plication and all received an infusion pump ( Accufuser Plus.McKinley Medical-Wheat Ridge, CO) for post operative pain management. The device is sterile, disposable, programmable and for ambulatory use . Continuous infusion of Bupivacaine at a concentration of 0.5% was given using a 360 ml reservoir, with a basal rate of 2.0 ml /hr, bolus volume of 2.0 ml and lockout intervals of 60 min. Patients wore the pain pump in a shoulder strap or in a fanny pack for 6 days.
Twenty five additional patients received standard (oral and intramuscular) post operative medications for pain and served as the control group.
All of the 50 patients were asked to complete an evaluation of their postoperative pain and discomfort after surgery using a grading scale.
RESULTS: A significant reduction in post operative pain and discomfort resulted from the use of the infusion pump. On the average, the control group required 37.5 pain meds while the exprimental 16.8. The average of bed ridden hours for the control was 40.8 hours while the experimental was 21.6 hours. Detailed findings will be presented in five tables.
CONCLUSION:The simplicity of installing and running the pump, the benefits of early ambulation and the reduced need and strength of post operative narcotics, make us feel very optimistic. Our study indicates that the group of patients with the pump required less narcotic pain medications and initiated mobility sooner than the group with no pump. Patients tolerated the device well and seemed very pleased. The ability to get out of bed sooner is a major contribution of this device since it reduces the risk of deep venous thrombosis and pulmonary embolus.