Scottsdale – Last month we highlighted an article about pain pumps in breast reconstruction. This month our focus is breast augmentation and pain pumps. The May 2208 issue of the Aesthetic Surgery Journal presented a large (644 patients) study about breast augmentation and pain pumps – the effectiveness and safety.

For the study, patients were given a choice of intermittent bolus or continuous flow catheters for pain control. Prior to discharge, a local anesthetic was instilled by a nurse into catheters for those patients receiving bolus self-administration.  Patients then instilled 1 to 2 additional doses of the agent during the first 24 hours and recorded pain scores in the evening and the following morning. For patients using continuous flow catheters, the local anesthetic was used to fill pumps that allowed up to 2 days of continuous flow at a rate of 2 mL (about 1/2 a tablespoon) per hour per side. These 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.

Impressively, 88 percent of patients who self-administered medication reported pain reduction on the evening of surgery, and 78% reported a reduction the following morning. Catheters were maintained for 1 day post-surgery in 544 patients and for 2 days by 100 patients. One patient developed an infection of unknown etiology that ultimately resulted in the loss of a unilateral implant.

The take home lesson for me on this study is that paim pump catheters work and extremely well in reducing pain for breast augmentation patients. Importantly, the study was performed in a prospective style, which adds strength to the conclusions obtained by the authors.  In summary, indwelling catheters for the postoperative instillation of bupivacaine are safe and effective in the management of postoperative pain.  Patients benefit from an additional form of analgesia, limited to the operative site, which is effective. Both continuous flow and intermittent bolus self-administration systems are effective and their patient ratings are indistinguishable.