title: Continuous wound infiltration system for postoperative pain management in gynecologic oncology patients.
abstract: OBJECTIVE
  Major open surgery for gynecologic cancer usually involves a long midline skin incision and induces severe postoperative surgical site pain (POSP) that may not be effectively controlled with the conventional management. We investigated whether combining a continuous wound infiltration system (CWIS, ON-Q PainBuster®) and intravenous patient-controlled analgesia (IV PCA) effectively decreases POSP, compared with IV PCA alone, in gynecologic oncology patients.
  
  
  METHODS
  This retrospective study included 62 Korean patients who received a long midline skin incision during gynecologic cancer surgery. The combined therapy group (n = 31), which received CWIS (0.5% ropivacaine infused over 72 h) and IV PCA (fentanyl citrate), and the IV PCA only group (n = 31) were determined using 1:1 matching. POSP was assessed using resting numeric rating scale (NRS) scores measured for 96 h after surgery, which were analyzed using a linear mixed model.
  
  
  RESULTS
  The slopes of the predicted NRS values from the linear mixed model were significantly different between the groups. Compared with the control group, the combined therapy group had lower predicted NRS scores for the first 72 h, but higher predicted scores between 72 and 96 h. Moreover, the mean NRS scores over the first 48 h postoperation were significantly lower in the combined therapy group than in the control group; the scores were similar in both groups during the remaining period. With the exception of a higher body mass index in the CWIS group, the other variables, such as the dosage and usage time of fentanyl citrate, use of additional painkillers, and side effects, including wound complications, did not differ between groups.
  
  
  CONCLUSIONS
  Combined therapy using CWIS and IV PCA may be a useful strategy for POSP management in gynecologic oncology patients.
authors.affiliation: Department of Obstetrics and Gynecology, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: Banghyun
authors.initials: B
authors.lastname: Lee
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
authors.forename: Kidong
authors.initials: K
authors.lastname: Kim
authors.affiliation: Department of Statistics, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
authors.forename: Soyeon
authors.initials: S
authors.lastname: Ahn
authors.affiliation: Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
authors.forename: Hyun-Jung
authors.initials: HJ
authors.lastname: Shin
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
authors.forename: Dong Hoon
authors.initials: DH
authors.lastname: Suh
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea.
authors.forename: Jae Hong
authors.initials: JH
authors.lastname: No
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University Bundang Hospital, 82, Gumi-ro 173 beon-gil, Bundang-gu, Seongnam-Si, Gyeonggi-Do, Republic of Korea. ybkimlh@snubh.org.|School of Medicine, Seoul National University, Seoul, Republic of Korea. ybkimlh@snubh.org.
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D005833:Genital Neoplasms, Female / Q000601:surgery*; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D010149:Postoperative Pain / Q000628:therapy*; D012189:Retrospective Studies
chemical_list: D005283:Fentanyl
keywords: Gynecologic neoplasm; Local anesthesia; Pain management; Patient-controlled analgesia; Postoperative pain