Portable Anesthetic Cuts Postoperative Pain

Device numbs incision site, can reduce time in hospital

WEDNESDAY, May 8, 2002 (HealthDayNews) -- Surgery is anything but a ball, but a ball of a different kind may ease your postoperative pain and bounce you out of the hospital more quickly.

The ON-Q Post-Operative Pain Relief System is called a "pain relief ball." More precisely, it is a balloon-like device that provides targeted pain relief after surgery by delivering a carefully measured flow of local anesthetic directly into the incision for a couple of days.

In other words, it keeps the site of the surgery numb so you don't feel as much pain.

A new Cleveland Clinic Florida study of women who had an abdominal hysterectomy found that 43 percent of those who used ON-Q didn't need the usual narcotics after their surgery, resulting in shorter hospital stays.

Nearly all the women who used ON-Q were able to return home within 24 hours. Three days is the typical hospital stay for someone who's had an abdominal hysterectomy.

"We had no infections, we had no readmissions. The ON-Q is an amazing little device," says Dr. Stephen E. Zimberg, the study's lead author and a gynecologist at Cleveland Clinic Florida in Weston.

The study included 30 women who used ON-Q for 48 hours. The ON-Qs contained either ropivacaine, bupivacaine, or lidocaine -- all local anesthetics. The women filled out a series of pain questionnaires for a week after being discharged from the hospital.

Ten percent of the women didn't need any additional pain medication beyond the ON-Q, and 33 percent of them used only a non-narcotic, over-the-counter painkiller such as ibuprofen. Zimberg says that's a major improvement over traditional postoperative treatments.

"That has a huge impact on patients and how they feel. They don't have the narcotic side effects. They're not drowsy, they don't have decreased bowel function that keeps them in the hospital for several days, they don't have the nausea or the itching or the allergy that you get" with narcotics, Zimberg says.

"The patients who did need narcotics afterwards… needed very few of them, and within days they needed nothing," he adds.

Patients aren't the only ones who benefit from ON-Q, Zimberg says. The study found a 30 percent savings in hospital costs for the women who used ON-Q.

The study was presented this week at the annual clinical meeting of the American College of Obstetricians and Gynecologists in Los Angeles.

ON-Q is like a small water balloon that can be filled with a local anesthetic selected by the surgeon. Maximum capacity is for five days. It's connected to a catheter, which is inserted into the incision and held in place when the incision is closed.

ON-Q can be attached to the patient's clothing, clipped to a belt, carried in a portable pouch, or taped to the skin. When it's empty, the system can be removed by the patient at home or by a doctor or nurse in a clinic or office.

The device, made by I-Flow of Lake Forest, Calif., can be used in different kinds of surgeries, including hysterectomies, cesarean sections, abdominal and hernia operations, knee replacements, mastectomies, and foot and ankle surgeries.

ON-Q was approved by the U.S. Food and Drug Administration in 1998. There are currently more than 30 ON-Q studies taking place in the United States and other countries.

One patient says it greatly reduced her pain after a C-section.

"I would absolutely insist on it for another C-section if I was going to have one -- or for any abdominal surgery," says Chris Carreon of Manhattan Beach, Calif.

She used ON-Q for four days. Not being distracted by pain or the effects of narcotics meant she could focus more on her new baby.

"It was just a really pleasant surprise to be that coherent afterward, and that much more able to deal with the responsibilities of being a mom," Carreon says.

What To Do: Here's where to find out more about ON-Q. To learn more about postoperative pain, try the National Library of Medicine.

SOURCES: Stephen E. Zimberg, M.D., gynecologist, Cleveland Clinic Florida, Weston, Fla.; Chris Carreon, Manhattan Beach, Calif.; May 6, 2002, presentation, annual clinical meeting, American College of Obstetricians and Gynecologists, Los Angeles
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