Pulse: Health: Pain, Pain, Go Away

A new device is changing the face of pain after surgery

Patients confronted with surgery usually worry about three things: Will I die from the anesthesia? Will I get better? Will it hurt a lot? No doctor can give an unqualified answer to any of these questions, but a new device is making it possible to promise little or no pain after certain kinds of operations.

                                                                                                           Pain normally concentrates at the spot where the surgeon’s scalpel slices into the body. Narcotics like Percocet, Demerol and morphine have long been the standard method for handling pain, basically flooding the whole body to quell the throbbing in one place. Problem is, they also tend to make people feel lousy, causing dizziness, nausea and constipation. Now there’s a way to deliver pain relief locally instead of systemically, with the new ON-Q PainBuster, a big step toward making heavy-duty painkillers obsolete.

“It’s so simple and foolproof that I wish I’d invented it,” says Dr. Mark Kaplan, a general surgeon at Albert Einstein Medical Center, one of the first hospitals in the area to introduce ON-Q, about 16 months ago. He uses it routinely when he’s fixing a hernia or opening a chest for lung surgery. The device, about the size of an apple, consists of a small balloon connected to a tiny catheter that the surgeon inserts near the incision before closing it up. The balloon gets filled with a local anesthetic that automatically drips into the wound and numbs the area, much like the Novocaine a dentist injects into your jaw. But unlike the short-acting needle, the medication can be released for as long as five days. When the balloon is empty, either the patient or the doctor removes the catheter and throws it away.

I learned about ON-Q from my friend Susan when I called her a week or so after her recent mastectomy with reconstruction. She told me the doctor had inserted ON-Q and she felt terrific. “All I needed was a little morphine in the hospital and maybe a few Dilaudid once I got home,” she said. “That’s nothing for a procedure like this.”

Several area doctors are including ON-Q as a routine part of their surgery. Lankenau heart surgeon Scott Goldman is a big fan of ON-Q because when patients aren’t uncomfortable and groggy from painkilling drugs, they get up and about more quickly. In May, he replaced an aortic valve on 66-year-old property manager Arthur Prevost. “I was sawed open about 12 inches, from the top of my chest to the bottom,” Prevost says, “and the only real pain came from the drainage tubes. All I needed when I got home was Tylenol.”

Not everybody has been won over by the ON-Q concept. Dr. Todd Nixon, a St. Mary cardiac surgeon, experimented with it for lung resections but wasn’t convinced it made much difference. Orthopedic surgeons like Dr. Richard Ruthann prefer pain injections and nerve blocks, particularly for joint replacements, because of the risk of infection from anything inserted near a wound. But Dr. Leonard Brody, a Holy Redeemer orthopedist, finds ON-Q works wonders with painful knee surgeries and shoulder arthroscopies.

Dr. Steven Copit, a Jefferson plastic surgeon, uses ON-Q nearly every day for all kinds of breast surgery — augmentations, reductions, reconstructions, lifts. “Patients can’t overdose, and it really takes the edge off,” he says. “It’s not going to change the face of surgery, but it does make it a lot more tolerable.”


No Pain, Big Gain
» You can find out more about ON-Q from its website, askyoursurgeon.com. The site includes references to studies showing ON-Q’s effectiveness in c-sections, –hysterectomies, and breast and open-heart surgery.
» If you’re scheduled for surgery, ask your doctor if you are a candidate for ON-Q. If he or she hasn’t used it before, the drug rep may provide ON-Q as a trial. The cost is minimal and usually covered by insurance.