On-Q pump for pain control after orbital implant surgery.
OBJECTIVE
To introduce an elastomeric continuous infusion pump for pain control after outpatient orbital implant surgery.


METHODS
Retrospective, noncomparative consecutive case series of all patients undergoing enucleation, evisceration, or secondary orbital implantation using the On-Q pain system between August 2004 and January 2006. Postoperative pain score, need for narcotics, and adverse events were recorded. The On-Q catheter is inserted intraoperatively through the lateral lower eyelid into the muscle cone under direct visualization, prior to the orbital implant placement. The On-Q system continually infuses anesthesia (bupivacaine) to the retrobulbar site for 5 days.


RESULTS
Among 20 patients, mean postoperative period pain score, with On-Q in place, was 1.3 (scale of 0 to 10). Nine patients (45%) did not need any adjunctive oral narcotics. Two patients experienced postoperative nausea. One catheter connector leaked, thereby decreasing delivery of retrobulbar anesthetic resulting a pain level of 6, the highest level in the study. There were no postoperative infections. No systemic toxic effects from bupivacaine were observed clinically.


CONCLUSIONS
The On-Q pain pump is widely available, low cost, and requires minimal patient manipulation for the use in orbital implant surgery. The device was safe and appeared to minimize postoperative pain in the authors' case series.
*Oculofacial and Cosmetic Surgery Associates, Eyesthetica; †Department of Ophthalmology, Keck School of Medicine, University of Southern California, Los Angeles; ‡Department of Ophthalmology, University of California at Irvine, Irvine; §La Jolla Laser Vision, La Jolla; and ║Department of Ophthalmology, University of California at San Diego, San Diego, California, U.S.A.
David B
DB
Samimi
Melanie H
MH
Erb
Arthur C
AC
Perry
Michael A
MA
Burnstine
Steven C
SC
Dresner
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000777:Anesthetics / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D015353:Eye Enucleation; D017234:Eye Evisceration; D058447:Eye Pain / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D008297:Male; D008875:Middle Aged; D020273:Orbital Implants; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D012189:Retrospective Studies
D000777:Anesthetics; D002045:Bupivacaine