The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia

Abstract

ObjectiveThe goal of this study was to compare postoperative surgical site pain in gynecologic cancer patients who underwent elective extended lower midline laparotomy and managed their pain with either the ON-Q pain management system (surgical incision site pain relief system, ON-Q pump) or an intravenous patient-controlled analgesia pump (IV PCA).MethodsTwenty gynecologic cancer patients who underwent elective extended lower midline laparotomy were divided into two groups. One group received a 72-hour continuous wound perfusion of the local anesthetic ropivacaine (0.5%, study group) into the supraperitoneal layer of the abdominal incision through the ON-Q pump. The other group received intravenous infusion pump of patient-controlled analgesia (fentanyl citrate 20 mg/mL · kg+ondansetron hydrochloride 16 mg/8 mL+normal saline). Postoperative pain was assessed immediately and at 6, 24, 48, 72, and 96 hours after surgery using the visual analogue scale.ResultsPostoperative surgical site pain scores at 24, 48, and 72 hours after surgery were lower in the ON-Q group than the IV PCA group. Pain scores at 24 hours and 48 hours after surgery were significantly different between the two groups (P=0.023, P<0.001). Overall painkiller administration was higher in the ON-Q group but this difference was not statistically significant (5.1 vs. 4.3, P=0.481).ConclusionThis study revealed that the ON-Q pain management system is a more effective approach than IV PCA for acute postoperative surgical site pain relief after extended lower midline laparotomy in gynecologic cancer patients.

Economic assessment of postoperative pain control strategies for treatment of adult patients with cancer

“…Therefore, four full-texts were considered as source of data for decision tree modeling and economic assessment regarding the control of postoperative pain related to cancer surgical treatment. [7][8][9][10] Three studies analyzed intravenous administration of postoperative analgesia, controlled by the patient, [8][9][10] and the fourth study indicated use of epidural analgesia 7 .…”

“…Only one study presented analgesia on demand, 9 and the other three presented continuous infusion with bolus, if necessary. 7,8,10 Two studies analyzed intensity of pain during the 48 hour period after surgery, 7,8 one study analyzed it during a period of 24 hours after surgery 9 and one study analyzed it during a period of 96 hours after surgery. 10 Each study analyzed different comparators and different combinations of medication for analgesia.…”

“…7,8,10 Two studies analyzed intensity of pain during the 48 hour period after surgery, 7,8 one study analyzed it during a period of 24 hours after surgery 9 and one study analyzed it during a period of 96 hours after surgery. 10 Each study analyzed different comparators and different combinations of medication for analgesia. Only one study directly compared fentanyl and sufentanil without associating other medication in the analgesia.…”

“…The decision tree considered two types of outcomes: effectiveness of postoperative analgesia (using VAS points of pain) and safety in postoperative control of pain (incidence of adverse side effects). [7][8][9][10] The main adverse side effects identified in the literature review that were associated with use of opioid anesthetics for control of postoperative pain 7-9 were occurrence of nausea and vomit.…”

Modified intermittent subfascial wound infiltration with local anaesthetic after open gastric bypass (wound infiltration aftrer gastric bypass)

“…Ozbiljnost ovog poremećaja je u značajnoj meri povezana sa primenom opioida 4 . Iako je efikasnost subfascijalne infiltracije rane lokalnim anestetikom potvrđena u hirurgiji jetre, želuca, materice, kolorektalne hirurgije, žučnih puteva i ortopedskoj hirurgiji, ima vrlo malo podataka o njenoj upotrebi u barijatrijskoj hirurgiji 1,5,6,7,8,9,10,11 . Prikazujemo slučaj modifikovane tehnike intermitentne subfascijalne infiltracije rane kod gojazne pacijentkinje, nakon otvorenog želu-dačnog bajpasa.…”