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October 24, 2005
9:00:00 AM - 10:30:00 AM
Room C306
Improved Management of after Open Varicocele Ligation Using Continuous Infusion of Local Anesthetic
Sandeep G. Mistry, M.D., Larry Lipshultz, M.D.
Scott Department of Urology, Baylor College of Medicine, Houston, Texas, United States
Introduction: Post-operative pain (POP) control is a major concern for patients and surgeons alike. As procedures become increasingly common in an outpatient setting, the monitoring of POP is less precise. Despite use of oral narcotics for pain control, a majority of patients undergoing outpatient surgery suffer pain classified as moderate to severe. The purpose of this study is to determine the utility of an elastomeric continuous infusion pump that delivers local anesthetic to a surgical incision (OnQ Painbusterâ) in patients undergoing outpatient open varicocele ligation.

Materials and Methods: Thirty-one patients who were to undergo either unilateral or bilateral varicocele ligation were enrolled in the study. Twenty-one patients had the OnQ Painbusterâ system inserted at the time of surgery. The pump delivered a continuous infusion of 0.25% Marcaine to the surgical site. The device was removed by the patient while at home on POD 2. The control group consisted of ten patients who had their surgical wounds injected with 0.25% Marcaine at time of surgery. Patients were contacted on post-operative day (POD) 0 by the primary surgeon (LL) and then on POD 1,2 and 7 by an unbiased, blinded research assistant (DM). Subjects were asked to rate their pain on a visual analog scale from 1 to 5, report the number of oral pain tablets taken, and asked to rate their return to the routine activities of daily living (ADL) on a scale of 1 to 5.

Results: No significant differences were noted in age, or BMI between the two groups. Mean pain scores were lower in the group receiving the device at all points and reached statistical significance on POD 1,2 and 7 (p= 0.045, 0.009, and .014 respectively). Mean number of oral pain pills taken was lower in the treatment group for all time periods and reached statistical significance on POD 1(p= 0.027). Finally, return to routine ADLs was improved in the group treated with the device reaching statistical significance on POD 7 (p=0.045). Patients receiving the pump experienced mild wound drainage, however, no infections or difficulty with device removal were noted.

Conclusions: Patients undergoing outpatient varicocele ligation had less pain, used fewer pain pills and had a quicker return to routine ADLs with use of the OnQ device. The most interesting finding, however, is that pain control and activity level was significantly improved even on POD 7, a full five days after the pump was removed. This finding suggests that improved local pain control has lasting effects after surgery. Larger studies are needed to investigate benefits of similar technology regarding work productivity and return of bowel function.

Anesthesiology 2005; 103: A613