USE OF A MARCAINE PUMP FOR THE CONTROL OF POST-OPERATIVE PAIN IN ABDOMINAL RECONSTRUCTION
Dr. Henry Mentz, Dr. Amado Ruiz, Dr. German Newall, Dr. Christopher Patronella 

MATERIALS AND METHODS: Ten patients had a Stryker Pain Pump 2 (Stryker Instruments, Kalamazoo, MI), which is a pain management device with the features of a PCA pump, yet is disposable and suitable for ambulatory use. This patient-controlled device provides continuous delivery of a non-narcotic cocktail via a thin, fenestrated catheter inserted in the abdominal wall or placed directly in top of the abdominal fascia. The pain relief system consists of a kinkless catheter (which helps prevent occlusion) and a balloon pump, which can be programmed to offer continuous infusion rates of 0.5,1, 2, 3, 4, 5, 6, 7, 8, 9, or 10ml per hour. Bolus programming allows for 1, 2, 3, 4, or 5ml. Bolus lockout times are 10, 20, 30, 45 ,60, 90, or 120 minutes. Programming lockout eliminates any possibility of the patient manipulating the settings, and a digital display provides constant infusion status at a determined Marcaine concentration. It has a sensor which sounds in the event 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 250cc and 400cc are available for administration of large volumes. Ten additional patients received standard oral and intramuscular post-operative medications for pain (e.g., Demerol, Percocet, Lortab) and were not provided with a PCA or pain pump. All of the patients were then asked to complete an evaluation of their post-operative pain and discomfort, the results of which are summarized in Table 1 and Table 2.

RESULTS: Our study reveals a significant reduction in post-operative pain and discomfort as a result of the use of the pain pump. Although the group with the pain pump was older (38.2 years versus 34.5), had more procedures (6.2 versus 4.8), and had weaker pain medicines (Classes II and III versus Class II), they still took far fewer post-operative narcotics (16.8 versus 37.5 pills), resumed normal activities sooner (Day 2.5 versus Day 7.5), and rated their recovery as better (7.8 versus 7.0) than the non-pump group. The simplicity of installing and running the pump, the benefits realized by patients (i.e., early ambulation, less pain, reduced need, and the strength of post-operative pain medications) all make us feel very optimistic that patients appreciate the use of this device. Our experience indicates patients get out of bed sooner with this device, thereby reducing the incidence of deep venous thrombosis and/or pulmonary embolus.

CONCLUSION: Although our initial results are very encouraging and suggest the use of a pain pump may justify the extra cost when performing abdominal wall reconstruction cases, we feel further research with more clinical cases is necessary in order to recommend the use of this device for pain management after an abdominoplasty.

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For additional information on this Medical Research article, please contact:

ACPS: The Aesthetic Center For Plastic Surgery
(713) 799-9999

Source: Dr. Henry Mentz
http://www.drmentz.com

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