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Fear of pain is one of the major concerns for most patients anticipating
surgery, says James Zins, M.D., Chairman, Cleveland Clinic Department of Plastic
Surgery. And managing postoperative pain, which can be intense, is challenging
because the most effective agents--narcotics such as morphine--also produce the
most troublesome side effects, particularly nausea and vomiting.
"Most patients who take a narcotic experience these side effects,"
says Dr. Zins. "For many, the nausea and vomiting are more worrisome than
the pain."
But a new approach to managing pain is helping Cleveland Clinic patients
reduce the need for narcotics in the wake of plastic surgery. The approach
involves delivering a long-acting, local anesthetic directly to the surgical
site via a catheter placed under the skin.
"We’ve seen significant pain relief with this approach," says Dr.
Zins, "particularly for our patients who have undergone breast
augmentation, abdominoplasty, forehead lifts and face lifts." He says the
approach produces more effective pain relief than narcotics "without the
narcotic side effects."
The system The Cleveland Clinic has been using for about a year, called the
ON-Q Painbuster, has two main components: a small, bulbous pump that holds the
pain-relieving drug and a catheter (tubing) through which the drug travels and
is released. Once a procedure is completed, the last few inches of the ON-Q
catheter are carefully buried in the surgical cavity using a minimally invasive
technique. The end of the catheter is as slender as a piece of spaghetti; it’s
designed like a garden soaker-hose, so it continuously and evenly bathes the
surgical site with the pain-relieving medication.
"It is extremely easy to insert at time of surgery," says Dr. Zins,
"and the catheter itself causes no discomfort after surgery."
Depending on the procedure and the patient, ON-Q may be used with or without
narcotics.
Flow of drug to the surgical site is automatically controlled by an elastic
membrane and a flow-regulator helps ensure a safe and continuous infusion.
Patients typically are prescribed enough drug to last one to three days after
surgery, says Dr. Zins. The portable, disposable pump can be carried in a pouch
or clipped to clothing. Once the pump empties, the catheter is removed by a
physician, nurse or even the patient.
He says the device has dramatically changed his practice. It has reduced the
need for postoperative overnight stays, shortened postoperative stays for
outpatient procedures, accelerated recuperation times and made recuperation a
much less unpleasant experience.
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