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Killing Pain One Drip at a Time

New technique leaves patients less distressed after surgeries

FRIDAY, Jan. 23, 2004 (HealthDayNews) -- In a growing number of operating rooms across the United States, surgeries are ending with a slightly different twist.

Rather than stitching up a patient and then prescribing various narcotics to control the pain that's bound to follow, doctors are leaving a tiny catheter-like device in the area of the incision. For the next few days, a local anesthetic drips automatically into the wound.

This not only stops the pain, say those who've used the technique, but it does so without the side effects of so many pain-killing drugs. That speeds recovery, advocates say, letting patients get up and around -- and out of the hospital -- much more quickly.

"The main point is that long-lasting local anesthesia reduces the need for narcotics, and that facilitates recovery," says Dr. Paul F. White, professor and former chairman of the department of anesthesiology and pain management at the University of Texas Southwestern Medical Center.

Two just-published studies by White confirm that people whose pain relief came via a catheter-drip reported less pain and needed 60 percent less narcotics than those not given the local anesthetic.

In one study, which involved 36 people who had open-heart surgery, everyone who had received a painkiller through a catheter-drip sat up in a chair and moved around on the first day after surgery. They also left the hospital sooner than those who did not get the drip.

In the second study, involving 24 people who had foot and ankle surgery, 40 percent of those who had the catheter-drip were discharged from the hospital on the day of their surgery. None of the others were discharged that day.

Results of the foot and ankle surgery appear in the November issue of Anesthesia and Analgesia; the study on the heart surgery patients appears in the October issue of Anesthesiology.

"A lot of factors influence the effectiveness [of the technique]," White says, including concentration and volume of the painkiller used. But, he says, it "works best when you can block a nerve or put [the catheter] near a nerve."

That was the case with the foot surgeries, he says, when the catheter-drip "blocked a particular nerve that innervates most of the foot." With the heart surgeries, it "blocked the pain fibers at the site of the chest incision." The drip also seems to require "less drug, or a lower concentration of the drug, if you're near a major nerve," White says.

But the technique has not produced good results with hip- and knee-replacement surgeries or with hysterectomies. And a study nearing completion at the University of Wisconsin is examining whether the catheter-drip will work with hernia surgery. Another research project, under way at The Johns Hopkins University School of Medicine in Baltimore, is testing the technique with radical prostate surgery.

Dr. Christopher Wu, an associate professor in the department of anesthesiology and critical care medicine at Hopkins, says that "preliminary data suggests [the catheter-drip system] does improve pain control, but how that is going to play out in comparison to other forms of pain control…is not clear at this point."

"In some cases you might still need narcotics," Wu says, mentioning abdominal surgery that involves a lot of deep wounds as an example. But even using the technique in conjunction with more traditional pain-killing medication would "decrease the number of opiates you use after surgery, and decrease the side effects," Wu says.

Narcotic painkillers commonly cause nausea, constipation and grogginess -- problems that can interfere with quick recovery and speedy discharge from the hospital.

Doctors using the technique lay a small catheter in the wound before it's closed, explains Wu. "It infuses some type of local anesthetic, just like you'd get when you go to the dentist, to numb up the wound area."

The catheter is "very tiny," White says. "It's non-electronic. There are no gizmos and gadgets to adjust. It's very, very simple."

The idea, apparently, isn't entirely new. Years ago, White says, such a procedure was mentioned in surgical literature but wasn't followed up because the appropriate equipment had not yet been developed. Now, though, several manufacturers have filled that void. White's two studies both used the ON-Q Post-Operative Pain Relief System, made by the I-Flow Corp. of Lake Forest, Calif.

Patients seem to like the technique, too. People who've participated in studies on the pain control method report less pain, and greater satisfaction with the management of their post-operative pain, than do people not treated with the system, both White and Wu report.

"Narcotics themselves don't modify pain signals," Wu says, "but local anesthetic at the site [of the wound] can decrease the amount of pain signals."

More information

To learn more about traditional options for managing pain after surgery, check out information from the American Academy of Family Physicians. For more on controlling post-operative pain in children, visit Yale-New Haven Hospital.

SOURCES: Paul F. White, M.D., Ph.D., professor, department of anesthesiology and pain management, University of Texas Southwestern Medical Center, Dallas; Christopher Wu, M.D., associate professor, department of anesthesiology and critical care medicine, The Johns Hopkins University School of Medicine, Baltimore; October 2003 Anesthesiology; November 2003 Anesthesia and Analgesia
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