title: Prospective, randomized, double-blind trial of local anesthetic infusion and intravenous narcotic patient-controlled anesthesia pump for pain management after free TRAM flap breast reconstruction.
abstract: BACKGROUND
  : This study assessed the efficacy of a continuous infusion pump system for postoperative pain control at muscle-sparing transverse rectus abdominis musculocutaneous (TRAM) flap donor sites.
  
  
  METHODS
  : In this prospective, randomized, double-blind trial, a dual-catheter continuous infusion pump system was placed in the muscle-sparing TRAM flap donor-site area in all patients. Bupivacaine (0.375%; continuous infusion pump group) or isotonic saline (control group) was infused at 4 ml/hour. All patients also had a patient-controlled anesthesia system delivering intravenous narcotics on demand. Pain scores, patient satisfaction, narcotic use, milestones of surgical recovery, and side effects of narcotics were compared between the two groups.
  
  
  RESULTS
  : Forty-eight patients were included in the study (23 continuous infusion pump patients and 25 control patients). The continuous infusion patients used less mean patient-controlled anesthesia narcotic during the first 2 postoperative days (78.0 mg versus 42.7 mg; p = 0.019) and transitioned earlier to oral narcotics than did control patients. Patients' overall pain satisfaction scores were significantly better in the continuous infusion group than in the control group. There were no significant differences between groups with regard to overall abdominal pain intensity scores, total narcotic use, length of hospitalization, incidence of narcotic side effects, or milestones of surgical recovery.
  
  
  CONCLUSIONS
  : The continuous infusion pump system appears to be a safe and effective method for postoperative donor-site pain management in TRAM flap breast reconstruction patients and should be considered for postoperative donor-site pain management. However, continuous infusion pump local anesthetic delivery to the muscle-sparing TRAM flap donor site did not eliminate narcotic use for pain control.
authors.affiliation: Houston, Texas From the Departments of Plastic Surgery and Anesthesiology and Pain Medicine and the Division of Quantitative Sciences, University of Texas M. D. Anderson Cancer Center.
authors.forename: Lior
authors.initials: L
authors.lastname: Heller
authors.forename: Alicia M
authors.initials: AM
authors.lastname: Kowalski
authors.forename: Caimiano
authors.initials: C
authors.lastname: Wei
authors.forename: Charles E
authors.initials: CE
authors.lastname: Butler
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D016462:Mammaplasty; D008875:Middle Aged; D009294:Narcotics; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D017568:Rectus Abdominis / Q000637:transplantation; D013524:Surgical Flaps
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009294:Narcotics