Infusion devices delivering local anesthetic directly to the operative site have improved postoperative analgesia in a number of plastic surgical procedures, including abdominoplasty.1 To ensure optimal analgesic effect, correct placement of the infusion catheters is important. In the case of abdominoplasty, this is generally achieved by suturing the catheters to the anterior rectus sheath.
We have used another method without sutures that will also deliver anesthetic directly to the rectus muscles. After excision of excess skin and subcutaneous tissues and plication of any rectus abdominis divarication, the catheters are introduced through the skin with a trocar in the usual fashion. Small holes are made in the anterior rectus sheath bilaterally, and the catheters are fed in and out of a subfascial plane until they reach the superior aspect of the surgical field (Fig. 1).
We have found that this technique provides excellent postoperative analgesia and that the catheters are held securely while the abdominolasty wound is closed as well as during the immediate postoperative period. We have had no difficulty in removing the catheters once they are no longer required.
David Stewart, M.R.C.S.
Andrew Yue, F.A.N.Z.C.A.
Mark Gianoutsos, F.R.A.C.S.(Plast.)
Surgical and Orthopedic Research Laboratories
Prince of Wales Hospital
Randwick, Sydney, Australia
1. Mentz, H. A., Ruiz-Razura, A., Newall, G., and Patronella, C. K. Use of a regional pain pump to control postoperative pain after an abdominoplasty. Aesthetic Plast. Surg.
29: 415, 2005.
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