Purpose: We sought to determine the efficacy of an extraction-incision infusion of local anesthetics through a continuous-infusion elastomeric pump (ON-Q) for the management of postoperative analgesia after laparoscopic nephrectomy and laparoscopic nephroureterectomy with intact specimen extraction.
Patients and methods: We performed a retrospective comparative analysis of 38 consecutive patients undergoing either laparoscopic nephrectomy or laparoscopic nephroureterectomy between October 2006 and November 2007 by an experienced single surgeon. Postoperative pain management with an ON-Q pump providing continuous local anesthetic into the incisional area was compared with traditional intravenous and oral analgesic use. Data sources were reviewed for analgesia requirements (morphine equivalents), tumor size, American Society of Anesthesiologists scores, complications, and length of hospitalization.
Results: After laparoscopic procedures, 18 patients received the ON-Q Pain Relief System while 20 received the traditional subcutaneous injection of 0.25% bupivacaine at the end of the procedure and standard orders for oral and IV narcotics for pain. Mean morphine equivalents used by the ON-Q and control groups were 35.4 and 47.5 mg, respectively (P = 0.1). Average length of hospitalization was 1.8 days and 2.9 days (P < 0.01), while mean tumor size was 5.2 cm and 3.7 cm (P < 0.05) in the ON-Q and control group, respectively.
Conclusion: A continuous infusion of 0.25% bupivacaine at 4 mL/hour through the ON-Q elastomeric infusion pump is a safe and effective adjunct in postoperative pain management after laparoscopy. Initial experience with the ON-Q Pain Relief System results in decreased narcotic use and decreased length of hospitalization compared with traditional postoperative pain management.