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Non-Narcotic Pain Relief Pump Allows Hysterectomy Patients to go Home Within One to Two Days After Surgery : Presented at ACOG

By Ed Susman
Special to DG News

LOS ANGELES, CA -- May 7, 2002 -- Thirteen out of 30 patients undergoing hysterectomies did not require narcotic analgesia after being placed on a new external pump that delivered local anesthesia into the surgical wound, researchers reported here yesterday at the 50^th annual meeting of the American College of Obstetricians and Gynecologists.

In addition, patients who were fitted with the On-Q catheter-based pain management system were able to leave the hospital one to two days earlier than patients who did not receive the system, said Stephen Zimberg, MD, a gynecologist at Cleveland Clinic Florida, Fort Lauderdale. About half the patients were able to leave the hospital a day after surgery; the rest of the patients on the device were able to leave within 48 hours, Dr. Zimberg said.

The patients in the study, sponsored by I-Flow Corporation, Lake Forest, Calif., were compared to historical controls-surgical patients who were also operated on at the Florida clinic but were not given the On-Q system. Those patients required three to four days in hospital.

Alan Dine, BSN, director of clinical research at I-Flow, said that patients on the On-Q system, because they required less narcotics, had their bowel function return to normal more rapidly and that may have resulted in shorter hospital stays. He said that less use of narcotics can also reduce risk of respiratory depression, another factor in extending hospital stays.

"If we can save two days in the hospital that will be well received by managed care," said Gary Liscomb, MD, director of gynecology at the University of Tennessee Health Science Center, Memphis, Tennessee. Dr. Liscomb said he had been skeptical about whether the system would work, but having seen results in other trials that were similar to those achieved by Dr. Zimberg's patients, "I am no longer a Doubting Thomas."

The On-Q system is a plastic pump that is filled with up to a five-day supply of local anesthetic. The baseball-sized device is worn in a "fanny-pack" or can be taped to the side of the patient. Two catheters are introduced through the skin and are placed in the hysterectomy wound.

The women in the study received doses of ropivacaine, bupivacaine of lidocaine at the rate of 2 mL/hour. There were no significant differences in pain relief with any of the drugs. When the two-day supply of the anesthetic is exhausted, the catheters can be pulled free of the wound with a simple tug. The needle track through which the catheters are introduced close by themselves without need for sutures or adhesive bandages, according to Mr. Dine.

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