Paper
Sunday, November 4, 2007

96
This presentation is part of : Clinical Initiatives in the Acute Care Setting
Use of the On-Q Pain Relief System in Post Operative Cardiac Surgery Patients
Barbara Winship, RN, BSN, CMSRN, Cardiothoracic Step Down Unit, Maine Medical Center, Portland, ME, USA
Learning Objective #1: discuss the findings of a pain management study utilizing a new approach to pain medication administration in the cardiac surgery population.
Learning Objective #2: discuss the unexpected findings related to nausea and vomiting in the population and the importance of further studies
Background: The On-Q Pain Relief System consists of an elastometric pump that holds 270 ml of local anesthetic.  Studies using randomized controls have indicated that the device significantly improves post-operative pain while decreasing the amount of narcotic analgesia required. Findings also show a significant decrease in hospital length of stay which could result in significant cost reductions.

 

Purpose: The purpose of this study was to evaluate continuous infusion of local anesthetic (0.5% Bupivacaine using the On-Q Pain Relief System) in sternotomy incisions in the post operative cardiac surgical patient. The hypothesis was that subjects with the device in place would have less pain, less narcotic usage and less nausea.

 Methods: This was a quasi-experimental study of one hundred eighty six open-heart surgery patients. Subjects were enrolled into the experimental group (67) or the control (119) by the cardiac surgeon. Pain scores and nausea were measured daily post-operatively through day 3 and patient demographics included a history of narcotic use.

 Results: The On-Q catheter reduced pain on post-op day 1 when subjects were getting up. Among the experimental group, 11.6% reported no pain, however 27.9% reported severe pain. In the control group none of the subjects reported no pain but 30.3% reported severe pain (p=.019). No statistically significant differences in pain scores were found on post-op days 2-3. Patients in both groups reported similarly on nausea. In the experimental group, a history of narcotic use was more common compared to the control group. This difference was statistically significant (p=.016).

 

Conclusions: The results did not support our hypothesis or the findings of previous studies. Given the potential for infection with this catheter in place as well as cost of the device there is no benefit to placing the catheter in this patient population.

 

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