Continuous infusions of local anesthetics for postoperative analgesia have been used for several years by numerous surgical subspecialties. Plastic surgery has only recently embraced these pain pumps, most of which have been used in breast and abdominal surgery. Many different pain pump systems are available. They have been used in many studies and have been found to be effective in improving postoperative analgesia, decreasing narcotic use, and decreasing nausea and vomiting. They have little associated morbidity and systemic toxicity. However, the efficacy of these pain pumps in various areas of plastic surgery need to be studied in well-designed prospective clinical trials. The present paper reviews the current status of the available evidence, usefulness and limitations of the use of pain pumps in plastic surgery.
LiuSS, RichmanJM, ThirlbyRC, WuCL. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: A quantitative and qualitative review of randomized controlled trials.J Am Coll Surg2006; 203: 914-32.
2.
PuLLQ. The use of a pain pump for optimal postoperative pain management.Plast Reconstr Surg2006; 117: 2066-9.
3.
ChesterJF, RavindranathK, WhiteBD, ShanahanD, TaylorRS, Lloyd-WilliamsK. Wound perfusion with bupivacaine: Objective evidence for efficacy in post-operative pain relief.Ann R Coll Surg Engl1989; 71: 394-6.
4.
EnnekingFK, IlfeldBM. Major surgery in the ambulatory environment; continuous catheters and home infusions.Best Pract Res Clin Anaesthesiol2002; 16: 285-94.
5.
BaroodyM, TameoM, DabbRW. Efficacy of the PainPump catheter in immediate autologous breast reconstruction.Plast Reconstr Surg2004; 114: 895-99.
6.
GibsonMP, VetterT, CrowJP. Use of continuous retropleural bupivacaine in postoperative pain management for pediatric thoracotomy.J Ped Surg1999; 34: 199-201.
7.
BarronDJ, TolanMJ, LeaRE. A randomized control trial of continuous extra-pleural analgesia post-thoracotomy: Efficacy and choice of local anesthetic.Eur J Anaesthesiol1999; 16: 236-45.
8.
ZoharE, FredmanF, PhillopovA, JedeikinR, ShapiroA. The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy.Anesth Analg2001; 93: 482-7.
9.
IlfeldBM, GearenPF, EnnekingFKTotal knee arthroplasty as an overnight-stay procedure using continuous femoral nerve blocks at home: A prospective feasibility study.Anesth Analg2006; 102: 87-90.
10.
CheongWK, Seow-ChoenF, EuKW, TangCI, HeahSM. Randomized clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy.Br J Surg2001; 88: 357-9.
11.
FredmanB, ShapiroA, ZoharE. The analgesic efficacy of patient controlled ropivacaine instillation after cesarean delivery.Anaesth Anal2000; 91: 1436-40.
12.
SherwinterDA, GhaznaviAM, SpinnerD, SavelRH, MacuraJM, AdlerH. Continuous infusion of intraperitoneal bupivacaine after laparoscopic surgery: A randomized controlled trial.Obes Surg2008; 18: 1581-6.
13.
GrantAJ, WoodC. The effect of intraneural local anesthetic infusion on pain following major lower limb amputation.Scott Med J2008; 53: 4-6.
14.
MagnaniE, CorosuR, MancinoP, BorgiaML. Postoperative analgesia after cesarean section by continued administration of levobupivacaine with the On-Q Painbuster system over the fascia vs ketorolac + morphine i.v.Clin Exp Obstet Gynecol2006; 33: 223-5.
15.
SchellSR. Patient outcomes after axillary lymph node dissection for breast cancer: Use of postoperative continuous local anesthetic infusion.J Surg Res2006; 134: 124-32.
16.
WheatleyGH, RosenbaumDH, PaulMCImproved pain management outcomes with continuous infusion of local anesthetic after thoracotomy.J Thorac Cardiovasc Surg2005; 130: 464-8.
17.
LeBlancKA, BellangerD, RhynesVK, HausmannM. Evaluation of continuous infusion of 0.5% bupivacaine by elastomer pump for postoperative pain management after open inguinal hernia repair.J Am Coll Surg2005; 200: 198-202.
18.
SchurrMJ, GordonDB, PellinoTA, ScanlonTA. Continuous local anesthetic infusion for pain management after outpatient inguinal herniorrhaphy.Surgery2004; 136: 761-9.
19.
KatzJ, JacksonM, KavanaghBP, SandlerAN. Acute pain after thoracic surgery predicts long-term post-thoracotomy pain.Clin J Pain1996; 12: 50-5.
20.
BanerjeeSS, PulidoP, AdelsonWS, FronekJ, HoeneckeHR. The efficacy of continuous bupivacaine infiltration following arthroscopic rotator cuff repair.Arthroscopy2008; 24: 397-402.
21.
WebbD, GuttmanD, CawleyP, LubowitzJH. Continuous infusion of a local anesthetic versus interscalene block for postoperative pain control after arthroscopic surgery.Arthroscopy2007; 23: 1006-11.
22.
MorganSJ, JerayKJ, SalimanLHContinuous infusion of local anesthetic at iliac crest bone graft sites for post operative pain relief: A randomized double-blind study.J Bone Joint Surg Am2006; 88: 2606-12.
23.
WuCL, PartinAW, RowbingsonAJ, KalishMA, WalshPC, FleischerLA. Efficacy of continuous local anesthetic infusion for postoperative pain after radical retropubic prostatectomy.Urology2005; 66: 366-70.
24.
CottamDR, FisherB, AtkinsonJA randomized trial of bupivacaine pain pumps to eliminate the need for PCA pumps in primary laparoscopic Roux-en-Y gastric bypass.Obes Surg2007; 17: 595-600.
25.
PacikPT, WernerC, JacksonN, LobsitzC. Pain control in augmentation mammaplasty: The use of indwelling catheters in 200 consecutive patients.Plast Reconstr Surg2003; 111: 2090-6.
26.
LuL, FineNA. The efficacy of continuous local anesthetic infiltration in breast surgery: Reduction mammaplasty and reconstruction.Plast Reconstr Surg2005; 115: 1927-34.
27.
LoskenA, ParrisJJ, DouglasTD, CodnerMA. Use of the infusion pain pump following transverse rectus abdominis muscle flap breast reconstruction.Ann Plast Surg2005; 54: 479-82.
28.
KrygerZB, RawlaniV, LuL, FineNA. Decrease post-operative pain, narcotic and antiemetic use after breast reduction using a local anesthetic pain pump.Ann Plast Surg2008; 61: 147-52.
29.
RawlaniV, KrygerZB, LuL, FineNA. A local anesthetic pump reduces pain and narcotic and antiemetic use in breast reconstruction surgery: A randomized controlled trial.Plast Reconstr Surg2008; 122: 39-52.
30.
KazmierFR, HenrySL, ChristiansenD, PuckettCL. A prospective, randomized, double-blind, controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation.Plast Reconstr Surg2008; 121: 711-5.
31.
HellerL, KowalskiAM, WeiC, ButlerCE. Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction.Plast Reconstr Surg2008; 122: 1010-8.
32.
BrayDA, NguyenJ, CraigJ, CohenBE, CollinsDR. Efficacy of a local anesthetic pump in abdominoplasty.Plast Reconstr Surg2007; 119: 1054-9.
33.
MentzHA, Ruiz-RazuraA, NewallG, PatronellaCK. Use of a regional infusion pump to control postoperative pain after an abdominoplasty.Aesth Plast Surg2005; 29: 415-21.
34.
KulkarniM, ElliotD. Local anaesthetic infusion for postoperative pain.J Hand Surg2003; 28: 300-6.
