Use of the On-Q system for pain management after robot - assisted endoscopic transaxillary thyroidectomy

Park, Woo Young; Kim, Ki Jun; Min, Kyoung Tae; Choi, Seung Ho; Lee, Sung Jin; Chung, Woong Youn

Clinical Research

Spinal Pain

Anesthesia and Pain Medicine 2013;8(4):216-221.
Published online October 30, 2013.

Use of the On-Q system for pain management after robot - assisted endoscopic transaxillary thyroidectomy

Woo Young Park, Ki Jun Kim, Kyoung Tae Min, Seung Ho Choi, Sung Jin Lee, Woong Youn Chung

¹Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea.
²Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea. kkj6063@yuhs.ac
³Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Abstract

BACKGROUND
The robot-assisted transaxillary approach to thyroid surgery is a novel method that has recently been used to improve patient safety and cosmetic outcomes. We evaluated post-operative pain, following robot-assisted endoscopic transaxillary thyroid surgery, and pain relief using a continuous wound perfusion system with local anesthetics.
METHODS
In a control group of 25 female patients who underwent robot-assisted endoscopic transaxillary thyroidectomy, the post-operative pain scores and characteristics as well as analgesic use were monitored. Fifty female patients undergoing robot-assisted endoscopic transaxillary thyroidectomy were given the On-Q system. They were then randomly assigned to receive one of two different local anesthetic doses: Group I (0.25% Ropivacaine, n = 25); and Group II (0.375% Ropivacaine, n = 25). The pain score, pain site, analgesic requirements and side effects of each group were recorded during the 48 hour period post-surgery.
RESULTS
Post-operative pain scores and analgesic demand were lower in the On-Q groups than in the control group. No difference was found between Group I and Group II. Until 6-12 hours after surgery, pain was mainly located in the axilla, while after 6-12 hours, the primary location of pain had a tendency to move to the neck. Pain scores gradually decreased in time for all patients.
CONCLUSIONS
Patients who underwent robot-assisted endoscopic transaxillary thyroidectomy with an On-Q system injecting 0.25% ropivacaine had lower pain scores, showing the effectiveness of the system. As a potential pain blocker, continuous wound perfusion with the On-Q system attenuates side effects. This could lead to shortened hospital stays after robot-assisted endoscopic transaxillary thyroidectomy.

Key Words: Local anesthetics, Pain relief, Robotics, Subcutaneous infusion, Thyroidectomy