In an effort to give patients an additional effective form of analgesia, indwelling catheters for the instillation of a long-acting local anesthetic have been used to alleviate postoperative pain in patients undergoing augmentation mammaplasty. In a prospective study, Pacik and coworkers analyzed the safety and efficacy of this form of pain control in a consecutive series of 644 patients. Patients were given a choice of intermittent bolus or continuous flow catheters for pain control. Prior to discharge, 20 mL of 0.25% bupivicaine with 1:400,000 epinephrine was instilled by a nurse into catheters for those patients receiving bolus self-administration. Pain scores for each side were recorded both before and 30 minutes after instillation. Patients then instilled 1 to 2 additional doses of bupivicaine during the first 24 hours and continued to record pain scores in the evening and following morning. For patients using continuous flow catheters, 0.25% bupivicaine without epinephrine was used to fill pumps that allowed up to 2 days of continuous flow at a rate of 2 mL per hour per side. Patients recorded pain at time intervals similar to those of patients using bolus self-administration. Questionnaires were given to all patients to determine the extent of pain reduction following the instillation of local anesthesia. More than 200 complete questionnaires were gathered, and pain scores from each of these were analyzed to gauge the efficacy of the instillation regimen. Eighty-nine percent of the patients who self-administered a bolus of bupivacaine reported pain reduction on the evening of surgery, and 78% reported a reduction on the following morning, before implant mobility exercises. Catheters were maintained for 1 day postoperatively by 544 patients (84%) and for 2 days by 100 patients (16%). One patient developed an infection of unknown etiology that ultimately resulted in the loss of a unilateral implant.

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: A prospective study of 644 consecutive augmentation mammaplasty patients showed that indwelling catheters for the postoperative instillation of bupivacaine were both safe and effective in the management of postoperative pain.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: Giving the patient an additional form of analgesia, limited to the operative site, was helpful in a multimodal pain management program. Both continuous flow and intermittent bolus self-administration systems were effective and their patient ratings were indistinguishable. Besides the promising findings generated in this study, it is noteworthy for the large number of subjects Pacik and colleagues were able to recruit. It suggests that the findings may be generalized across a number of pain conditions.

PT Pacik et al. Pain control in augmentation mammaplasty: safety and efficacy of indwelling catheters in 644 consecutive patients. Aesthetic Surgery Journal, 2008;28:279-284.