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A Local Anesthetic Pump Reduces Postoperative Pain and Narcotic and Antiemetic Use in Breast Reconstruction Surgery: A Randomized Controlled Trial

Rawlani, Vinay B.S.; Kryger, Zol B. M.D.; Lu, Leonard M.D.; Fine, Neil A. M.D.

Plastic and Reconstructive Surgery: July 2008 - Volume 122 - Issue 1 - p 39-52
doi: 10.1097/PRS.0b013e3181774349
Breast: Original Articles

Background: The purpose of this study was to conduct a double-blind, randomized, prospective trial evaluating the efficacy of a local anesthetic pain pump in reducing postoperative pain, narcotic use, and the incidence of postoperative nausea and vomiting in breast reduction surgery.

Methods: Thirty-one patients undergoing bilateral breast reduction using a single technique (inferior pedicle, Wise pattern with supplemental liposuction) were enrolled. The patients were randomized to receive either 0.25% bupivacaine (n = 16) or 0.9% saline (n = 15) delivered over a period of 48 to 55 hours. All patients were monitored postoperatively and completed a written survey and telephone interview. Parameters measured over a period of 48 hours included subjective pain, episodes of postoperative nausea and vomiting, and the amount of narcotics and antiemetics used.

Results: There were no statistically significant differences between the two groups regarding patient age, body mass index, weight of the breast reduction, complication rate, and standardized subjective pain perception. Patients randomized to bupivacaine reported significantly lower pain scores on the day of surgery and on the first and second postoperative days when compared with patients receiving placebo (p < 0.01). The amount of intravenous and oral narcotics used paralleled the reduction in pain (p < 0.01), and there were fewer episodes of postoperative nausea and vomiting and antiemetics used in the patients randomized to the bupivacaine group (p < 0.01).

Conclusion: The results of this study support the efficacy of a postoperative local anesthetic pain pump in reducing pain, narcotic use, and postoperative nausea and vomiting in women undergoing breast reduction.

Chicago, Ill.

From the Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine.

Received for publication July 26, 2007; accepted November 29, 2007.

Disclosures: The authors have no financial interest in any product or technique mentioned in this article. They have no commercial association with any company related to this study. Funding for this project came primarily from internal funding from the Division of Plastic Surgery at Northwestern University. The pain pumps were donated by the manufacturer, McKinley Medical, Ltd.

Neil A. Fine, M.D., Division of Plastic Surgery, Northwestern University Feinberg School of Medicine, 675 North St. Clair, Suite 19-250, Chicago, Ill. 60611,

©2008American Society of Plastic Surgeons