Continuous elastomeric pump-based ropivacaine wound instillation after open abdominal aortic surgery: how reliable is the technique?

Abstract

INTRODUCTION:

We aimed at quantifying the impact of continuous wound infusion with ropivacaine 0.33% on morphine administration and subjective pain relief in patients after open abdominal aortic repair in a double-blind, placebo-controlled study.

METHODS:

Before closing the abdominal wound, 2 multihole ON-Q® Soaker Catheters™ (I-Flow Corporation, Lake Forest, California, USA) were placed pre-peritoneally in opposite directions. Either ropivacaine 0.33% or saline 0.9% was delivered by an elastomeric pump at a rate of 2 mL/h for 72 hours in each of the catheters. Postoperative pain and morphine administration were assessed using the numerical rating scale (NRS) in 4-hour intervals. Total plasma concentrations of ropivacaine, unbound ropivacaine, and α1-acid glycoprotein (AAG) were measured daily. Mean arterial pressure, pulse rate, oxygen saturation, total amount of morphine administration, ventilation time, and length of stay in the intensive care unit (ICU) were recorded. At the end of the study period, the wound site and the condition of the catheters were assessed.

RESULTS:

The study was terminated prematurely due to a malfunction of the elastomeric balloon pump resulting in toxic serum levels of total ropivacaine in 2 patients (11.4 μmol/L and 10.0 μmol/L, respectively) on the second postoperative day. Six patients had been allocated to the ropivacaine group, and 9 patients had been allocated to the control group. Demographic and surgical data were similar in both groups. During the first 3 postoperative days, no difference between the ropivacaine and the control group was found in NRS (P = .15, P = .46, and P = .88, respectively) and morphine administration (P = .48). Concentrations of unbound serum ropivacaine (0.11 ± 0.08 μmol/L) were below toxic level in all patients.

CONCLUSION:

Continuous wound infusion of ropivacaine 0.33% 2 mL/h using an elastomeric system was not reliable and did not improve postoperative pain control in patients after open abdominal aortic surgery.

• Authors: Werner Baulig, Konrad Maurer, Oliver Michel Theusinger, Valentin Hinselmann, Barbara Baulig, Donat Rudolph Spahn, Marco Piero Zalunardo
• Journal: The heart surgery forum (Heart Surg Forum) Vol. 14 Issue 1 Pg. E51-8 (Feb 2011) ISSN: 1522-6662 [Electronic] United States
• PMID: 21345776 (Publication Type: Controlled Clinical Trial, Journal Article)

Chemical References

• Amides
• Anesthetics, Local
• Elastomers
• Ropivacaine

Topics

• Aged
• Amides (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Aorta, Abdominal (surgery)
• Elastomers
• Female
• Humans
• Infusion Pumps
• Male
• Pain Measurement (drug effects)
• Pain, Postoperative (prevention & control)
• Placebo Effect
• Ropivacaine
• Treatment Outcome
• Vascular Surgical Procedures (adverse effects)