Obstet Gynecol Sci.  2013 Mar;56(2):93-101. 10.5468/OGS.2013.56.2.93.

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

• Chung D
• Lee YJ
• Jo MH
• Park HJ
• Lim GW
• Cho H
• Nam EJ
• Kim SW
• Kim JH
• Kim YT
• Kim S

• KMID: 1425656
• DOI: http://doi.org/10.5468/OGS.2013.56.2.93

Abstract

OBJECTIVE
The 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).
METHODS
Twenty 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.
RESULTS
Postoperative 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).
CONCLUSION
This 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.

Keyword

Analgesia; Gynecologic neoplasm; Local anesthesia; Postoperative pain

MeSH Terms

Amides
Analgesia
Analgesia, Patient-Controlled
Anesthesia, Local
Citric Acid
Female
Genital Neoplasms, Female
Gynecology
Humans
Infusions, Intravenous
Laparotomy
Pain Management
Pain, Postoperative
Passive Cutaneous Anaphylaxis
Perfusion
Amides
Citric Acid

Figure

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  Fig. 1 Visual analogue scale (VAS): The VAS provides a simple and efficient measure of pain intensity that has been used widely and consists of a 10 cm horizontal line with the two endpoints labeled as "no pain" and "worst pain." The distance (centimeters) between the low end of the VAS and the patient's mark is used as a numerical index of pain intensity.

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  Fig. 2 Elastometric pump filled with local anesthetic. The protective cap is first removed from the pump, a syringe filled with local anesthetic is attached to the fill port, and the fluid is injected into the pump.

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  Fig. 3 Placement of infusion catheters. Inserting the Soaker catheters into the subfacial supraperitoneal layer (A). The introducer needle is placed approximately 3 cm from the midline incision (B).

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  Fig. 4 Mean change in postoperative surgical site pain. VAS, visual analogue scale; post op, postoperative; IV PCA, intravenous patient-controlled analgesia.

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