Continuous Elastomeric Pump-Based Ropivacaine Wound Instillation after Open Abdominal Aortic Surgery: How Reliable Is the Technique?


  • Werner Baulig
  • Konrad Maurer
  • Oliver Michel Theusinger
  • Valentin Hinselmann
  • Barbara Baulig
  • Donat Rudolph Spahn
  • Marco Piero Zalunardo



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 ?1-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 ?mol/L and 10.0 ?mol/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 ?mol/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.


Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. 2006. Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 202:297-305.nBeaussier M, El'Ayoubi H, Schiffer E, et al. 2007. Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: a randomized, double-blind, placebo-controlled study. Anesthesiology 107:461-8.nBlock BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL. 2003. Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA 290:2455-63.nDagtekin O, Hotz A, Kampe S, Auweiler M, Warm M. 2009. Postoperative analgesia and flap perfusion after pedicled TRAM flap reconstruction: continuous wound instillation with ropivacaine 0.2%. A pilot study. J Plast Reconstr Aesthet Surg 62:618-25.nFlores JA, Nishibe T, Koyama M, et al. 2002. Combined spinal and epidural anesthesia for abdominal aortic aneurysm surgery in patients with severe chronic pulmonary obstructive disease. Int Angiol 21:218-21.nForastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. 2008. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth 101:841-7.nFredman B, Zohar E, Tarabykin A, et al. 2001. Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery. Anesth Analg 92:189-93.nGómez Rios MA, Vázquez Barreiro L, Nieto Serradilla L, Diz Gómez JC, López Alvarez S. 2009. Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy [in Spanish]. Rev Esp Anestesiol Reanim 56:417-24.nKehlet H, Holte K. 2001. Effect of postoperative analgesia on surgical outcome. Br J Anaesth 87:62-72.nKehlet H, Wilmore DW. 2002. Multimodal strategies to improve surgical outcome. Am J Surg 183:630-41.nLevack ID, Holmes JD, Robertson GS. 1986. Abdominal wound perfusion for the relief of postoperative pain. Br J Anaesth 58:615-9.nLiu SS, Richman JM, Thirlby RC, Wu CL. 2006. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg 203:914-32.nMagnano D, Montalbano R, Lamarra M, et al. 2005. Ineffectiveness of local wound anesthesia to reduce postoperative pain after median sternotomy. J Card Surg 20:314-8.nMaurer K, Blumenthal S, Rentsch KM, Schmid ER. 2008. Continuous extrapleural infusion of ropivacaine 0.2% after cardiovascular surgery via the lateral thoracotomy approach. J Cardiothorac Vasc Anesth 22:249-54.nMuehling BM, Orend KH, Sunder-Plassmann L. 2009. Elective infrarenal abdominal aortic aneurysm repair—transperitoneal, retroperitoneal, endovascular? Interact Cardiovasc Thorac Surg 9:802-6.nPfeiffer U, Dodson ME, Van Mourik G, Kirby J, McLoughlin GA. 1991. Wound instillation for postoperative pain relief: a comparison between bupivacaine and saline in patients undergoing aortic surgery. Ann Vasc Surg 5:80-4.nPolglase AL, McMurrick PJ, Simpson PJ, et al. 2007. Continuous wound infusion of local anesthetic for the control of pain after elective abdominal colorectal surgery. Dis Colon Rectum 50:2158-67.nReady LB. 1999. Acute pain: lessons learned from 25,000 patients. Reg Anesth Pain Med 24:499-505.nRichman JM, Liu SS, Courpas G, et al. 2006. Does continuous peripheral nerve block provide superior pain control to opioids? A meta-analysis. Anesth Analg 102:248-57.nSalvemini S. 2008. New intraoperative therapeutic approach to control post-thoracotomy pain in patients who underwent main resection due to lung neoplasm [in Italian]. Minerva Chir 63:335-9.nThiveaud D, Demazieres V, Lafont J. 2005. Comparison of the performance of four elastomeric devices. Eur J Hospt Pharm Pract 11:54-6.nVintar N, Pozlep G, Rawal N, Godec M, Rakovec S. 2002. Incisional self-administration of bupivacaine or ropivacaine provides effective analgesia after inguinal hernia repair. Can J Anaesth 49:481-6.nWheatley GH 3rd, Rosenbaum DH, Paul MC, et al. 2005. Improved pain management outcomes with continuous infusion of a local anesthetic after thoracotomy. J Thorac Cardiovasc Surg 130:464-8.nWhite PF, Rawal S, Latham P, et al. 2003. Use of a continuous local anesthetic infusion for pain management after median sternotomy. Anesthesiology 99:918-23.n



How to Cite

Baulig, W., Maurer, K., Theusinger, O. M., Hinselmann, V., Baulig, B., Spahn, D. R., & Zalunardo, M. P. (2011). Continuous Elastomeric Pump-Based Ropivacaine Wound Instillation after Open Abdominal Aortic Surgery: How Reliable Is the Technique?. The Heart Surgery Forum, 14(1), E51-E58.