Abstract
Postoperative pain is a significant concern for patients who undergo surgery via a midline posterior approach to the occipitocervical junction and spinal axis. The development of the disposable, ambulatory pain pump presents a novel alternative for treatment of postoperative pain. The authors describe a multimodal treatment algorithm for postoperative pain after posterior occipitocervical junction surgery that uses the On-Q pain catheter system (I-Flow Corp., Lake Forest, CA) and a fentanyl patch.The On-Q PainBuster catheter system is a disposable, ambulatory device that allows for continuous anesthetic delivery directly into or adjacent to the wound. On-Q catheters are placed in the nuchal musculature for continuous infusion of 0.5% bupivacaine. The On-Q catheter infusion is continued for three days, and the catheters are then withdrawn. Patients are also provided with a transdermal fentanyl patch at the start of surgery.In regards to complications at our facility, there have been no cases of respiratory depression or arrest postoperatively and no wound infections, but one case of inadvertent subdural placement.The technique described for the use of the fentanyl patch and a continuous anesthetic delivery device in surgery of the occipitocervical junction presents a novel alternative to the current standard of care in pain control after suboccipital decompression.
Highlights
Postoperative pain is a significant concern for patients who undergo surgery via a midline posterior approach to the occipitocervical junction and spinal axis
The advent of the disposable, ambulatory pain pump presents a novel alternative for treatment of postoperative pain [3]
Continuous anesthetic delivery devices have been in use at our institution in general surgery, vascular surgery, orthopedic spine surgery, and occipitocervical junction and spine surgery since 2009
Summary
Postoperative pain is a significant concern for patients who undergo surgery via a midline posterior approach to the occipitocervical junction and spinal axis. How to cite this article Sivakumar W, Karsy M, Brock A, et al (June 17, 2016) Postoperative Pain Control with the Fentanyl Patch and Continuous Paravertebral Anesthetic Infusion after Posterior Occipitocervical Junction Surgery. The On-Q PainBuster (I-Flow Corp., Lake Forest, CA) catheter system is a disposable, ambulatory device that allows for continuous anesthetic delivery directly into or adjacent to the wound. This device (Figure 1) utilizes an elastomeric pump and a flow restrictor to maintain a continuous and consistent drug elution at a pressure of 10 lb/in. Once the catheters are placed, 5 ml of 0.25% bupivacaine is infused into each catheter At this time, patients are given 2.5 mg of intravenous (IV) diazepam to mitigate postoperative muscle spasm. Should a dressing change be required, it is performed in a sterile fashion
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