Infusion Pump for pain medication

I am having a Pannuculectomy on November 30, today I had my preop visit with Dr. Claire Marie Buckley at the University of Minnesota. She's had many years of PS experience with Bariatric Surgery patients. She was very patient and spent a good 45 minutes with me and answere all of my questions. She will be performing a panniculectomy with an Anchor or Fleur de Elis vertical incisions to deal with both the lower and upper part of the abdomen. I discussed the possibilty of placing an infusion pump for pain medication and she stated that she could do that and that this was up to me. She usually places two drains at the hip level and leaves them for two to three weeks or more if needed. She told me that the down side of the infusion pump for pain medication was that it is another fixture in addition to the drains that you need to deal with. She felt that the pain can be delat with with oral pain medication. I have two questions, first has anyone had any suregry performed by Dr. Buckley and can you share your experience and second what has been your experience and results  with the panniculectomy withn anchor cut and with an infusion pump for pain medication. I appreciate your feedback

Thanks

I do every tummy case with the pump. It does not numb the area totally, but it lowers the amount of narcotics you need dramatically.  A few tricks I learned over the past 4 years if using it:

Start it ahead of time, before patient wakes up, and their mind will be fooled into thinking they were never cut before they wake up.  Tremendously helps the psychological component of pain.

Use Ropivicaine as the medication...which lasts 12 hours...so it wears off so slowly patients don't get a "bump" in pain.

Combine it with other forms of pain control like a PCS and pills (Advil or the like) and you get a "triple whammy" effect on pain.

I hate pain, can ya tell ?

Thanks for the info.  I'm having a hysterctomy and want to partner it with TT.  Would you advise this?  How about a LBL?

Hi Dr LoMonaco, I had another question regarding the pain medication infusion pump, I understand that the pump is loaded with the pain medication and that this will last 4 to 5 days. Once the medication is gone, do you simply pull the catheter out like you would a drain tube? I assume I would need have this done by the surgeon.

I also had another question regarding seromas. It seems from reading this board that seromas are the number one complication, what is your advice in terms of how long do the drains need to stay in and does your level of activity post op have an effect on seroma complications? Is you have a higher level of activity are you more likely to have seromas?

One last question, do you recommned a high protein diet pre op and post op for faster healing?

Thanks for contributing your valuable time to answer questions

Hi Lacatana.

The pump I use lasts 2 days or so, but I use Ropvicaine, which lasts a lot longer than Novacaine.  Patients slide the little tube out themselves (its tiny...like the diameter of uncooked spaghettti).

Seromas really dont relate too much to the drains, and occur sporadically. Placing stitches called PTS sutures can "quilt" down the skin to the muscles and help prevent them.

I emphasize vitamins and balanced nutrition after surgery with 90g of extra protein per day.  Non-protein calories are very important.

Here is a short blurb on that:
http://www.drlomonaco.com/houston-body-lift-surgery.shtml

Thanks for your response Dr. L

What is PCS?

Summer, I do TT all the time after uncomplicated hysterectomies.  The LBL is different, though, because of the time on your tummy. I've done it after a simple vaginal hyst. one time.

I made a typo....meant PCA = Patient Controlled Analgesia.  Its a button you punch and it gives you an IV dose of morphine, demerol, dilaudid, or whatever every 10 min or so as you need it.

I had an infusion pump and like Dr L said when I woke up from my LBL I had to stop and think if I had has surgery because I didn't feel any pain...at first.  My blood pressure was really low that first night and the nurses didn't want to give me any more pain meds for fear it would bring it down even more.  I wasn't happy about that but I believe my pain would have been much worse had I not had the pain pump.  Of course once the dr came in that morning he told them to give me the pain meds and I was better after that.  I'd say go for it.  You will be happy you did!

I had ON-Q PainBuster pump & I think it helped GREATLY. I am a big wuss. I had it in for about 4 days. When I went to the Dr they just pulled it out with no fuss. I had to wear a fanny pack with the meds inside. I paid an addtional $200.00 and it was money WELL spent