'Pain Relief Ball' Cuts Opioid Use After Gynecologic Surgery

May 08, 2002

NEW YORK (MedscapeWire) May 09 — A balloon device known as ON-Q or the "pain relief ball" controls pain after hysterectomy and cesarean section (C-section) by dispensing local anesthetic into the surgical wound. At the American College of Obstetrics and Gynecology annual meeting, presenters of 2 separate studies suggested that ON-Q may be the new standard of care for postoperative pain control.

"Our patients who had just received a hysterectomy were comfortably moving around, clearly showing us that they were experiencing real pain relief," Stephen E. Zimberg, MD, lead presenter of one study from Cleveland Clinic Florida, says in a news release. "Nearly all of them were ready to go home only a day after surgery."

The narcotic-free ON-Q Post-Operative Pain Relief System provides targeted pain relief, decreasing narcotic use and reducing hospital stays and overall costs.

Zimberg's group randomized 30 women scheduled for elective abdominal hysterectomy for benign conditions to treatment with 0.5% ropivacaine, 0.5% bupivacaine, or 2% lidocaine delivered via ON-Q to the surgical site at a rate of 2 mL per hour.

Postoperatively, 10% of patients needed no additional pain medication beyond ON-Q, and 33% used only nonsteroidal anti-inflammatory drugs. Average length of stay was 24 ± 2 hours, and in-hospital costs were 30% lower than those of a comparable group of women managed with traditional pain control. There were no adverse effects.

In a separate study from the University of Tennessee Health Science Center in Memphis, ON-Q reduced opioid use after C-section by 40% and delivered equivalent pain relief.

"The 40% reduction in traditional narcotic use we found in patients using ON-Q is dramatic," says lead author Vanessa A. Givens, MD. "It allows these women to more fully enjoy the first precious days of life with their newborn, instead of suffering with narcotic side effects or pain after surgery."

In this prospective, double-blind study, patients undergoing C-section were randomized to receive an infusion of either 0.25% bupivacaine (n=20) or normal saline (n=16) into the incision site via ON-Q for 48 hours. Although pain perception reflected in visual analog scores was similar in both groups, the amount of morphine required for the same degree of postoperative pain relief was significantly less in the bupivacaine group at all time intervals. There were no infections or other significant adverse events. Ethicon provided the ON-Q Systems used in this study.

"The ON-Q Pain Management System appears to be effective in reducing postoperative morphine use after C-section," the authors write. "The significant reduction in narcotic use associated with the infusion of local anesthetic in this study suggests that a substantial amount of [post-C-section] pain is superficial in origin."

ACOG Annual Meeting. May 6-7, 2002.

Reviewed by Gary D. Vogin, MD

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