title: Epidural versus ON-Q local anesthetic-infiltrating catheter for post-thoracotomy pain control.
abstract: OBJECTIVE
  The authors compared thoracic epidural with ON-Q infiltrating catheters in patients having open thoracotomy to determine whether one method better relieves postoperative pain and would allow earlier discharge from the hospital and, hence, cost savings.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  University hospital.
  
  
  METHODS
  Fifty adult patients (24 to 81 years old) undergoing open thoracotomy by one surgeon.
  
  
  METHODS
  One group had thoracic epidural catheters placed by an anesthesiologist and then managed by the acute pain service. The other group had intraoperative ON-Q (ON-Q; I-Flow; Lake Forest, California) infiltrating catheters placed by the surgeon, wound infiltration with a local anesthetic, plus patient-controlled analgesia with an intravenous opioid.
  
  
  RESULTS
  The authors measured and compared average daily pain rating, maximum pain rating, time to discharge from the hospital, and total bill for hospital stay. Patients who received epidural analgesia had lower average pain scores on day 2 than did patients in the ON-Q group. Patients in the ON-Q group reported higher maximum pain scores on days 1 and 2 and at the time of discharge. Patients in the ON-Q group were discharged an average of 1 day earlier; hence, their average total bill was lower.
  
  
  CONCLUSIONS
  Even though the maximum pain score was higher in the ON-Q group, patients were comfortable enough to be discharged earlier, resulting in cost savings. ON-Q infiltrating catheters present a good option for providing postoperative analgesia to patients having an open thoracotomy.
authors.affiliation: Department of Pain Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA. rgebhardt@mdanderson.org
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Gebhardt
authors.forename: Reza John
authors.initials: RJ
authors.lastname: Mehran
authors.forename: Jose
authors.initials: J
authors.lastname: Soliz
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
authors.forename: Ashley K
authors.initials: AK
authors.lastname: Smallwood
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Feeley
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods*; D000772:Anesthesia, Local / Q000009:adverse effects / Q000379:methods*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002404:Catheterization; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D013908:Thoracotomy / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local