A prospective, randomized, double-blind, controlled trial of continuous local anesthetic infusion in cosmetic breast augmentation.
BACKGROUND
Narcotic pain medications are a significant component of most postoperative pain control regimens. Although they are usually effective, they produce several untoward side effects and sometimes provide inadequate analgesia. The continuous infusion of local anesthetic agents (via pain pump) has been used to supplement narcotic analgesics after various surgical procedures. The purpose of this study was to examine the effectiveness of the pain pump after cosmetic breast augmentation.


METHODS
Twenty-five women were enrolled in the study; five were eliminated from analysis because of data inadequacy or device problems. After bilateral augmentation, the remaining 20 patients received a 4-day continuous infusion of bupivacaine in one breast pocket and saline in the other. Laterality of bupivacaine infusion was randomized and blinded to both the patient and the surgeon. Patients completed a questionnaire on postoperative days 1, 2, 3, 4, and 7, rating their pain on a scale of 0 to 10, with 10 being worst.


RESULTS
On postoperative day 1, the mean pain score was 4.7 on the bupivacaine side versus 5.4 on the saline side (p = 0.36). On postoperative days 2, 3, 4, and 7, the mean scores were 4.3 versus 4.6 (p = 0.63), 3.3 versus 3.8 (p = 0.50), 3.4 versus 3.6 (p = 0.78), and 3.4 versus 3.1 (p = 0.63) for the bupivacaine and saline sides, respectively.


CONCLUSIONS
The pain pump appears to provide breast augmentation patients marginal improvement in pain control, although this advantage did not reach statistical significance in this study. The benefit, if real, also appears to wane over the first postoperative week.
Kazmier
Faeza R
FR
Columbia, Mo. From the Division of Plastic Surgery, University of Missouri.
Henry
Steven L
SL
Christiansen
Dustin
D
Puckett
Charles L
CL
D000328:Adult; D000779:Anesthetics, Local; D019928:Breast Implantation; D002045:Bupivacaine; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011446:Prospective Studies
D000779:Anesthetics, Local; D002045:Bupivacaine