Archives of Gynecology and Obstetrics

, Volume 295, Issue 5, pp 1219–1226 | Cite as

Continuous wound infiltration system for postoperative pain management in gynecologic oncology patients

  • Banghyun Lee
  • Kidong Kim
  • Soyeon Ahn
  • Hyun-Jung Shin
  • Dong Hoon Suh
  • Jae Hong No
  • Yong Beom KimEmail author
Gynecologic Oncology



Major open surgery for gynecologic cancer usually involves a long midline skin incision and induces severe postoperative surgical site pain (POSP) that may not be effectively controlled with the conventional management. We investigated whether combining a continuous wound infiltration system (CWIS, ON-Q PainBuster®) and intravenous patient-controlled analgesia (IV PCA) effectively decreases POSP, compared with IV PCA alone, in gynecologic oncology patients.


This retrospective study included 62 Korean patients who received a long midline skin incision during gynecologic cancer surgery. The combined therapy group (n = 31), which received CWIS (0.5% ropivacaine infused over 72 h) and IV PCA (fentanyl citrate), and the IV PCA only group (n = 31) were determined using 1:1 matching. POSP was assessed using resting numeric rating scale (NRS) scores measured for 96 h after surgery, which were analyzed using a linear mixed model.


The slopes of the predicted NRS values from the linear mixed model were significantly different between the groups. Compared with the control group, the combined therapy group had lower predicted NRS scores for the first 72 h, but higher predicted scores between 72 and 96 h. Moreover, the mean NRS scores over the first 48 h postoperation were significantly lower in the combined therapy group than in the control group; the scores were similar in both groups during the remaining period. With the exception of a higher body mass index in the CWIS group, the other variables, such as the dosage and usage time of fentanyl citrate, use of additional painkillers, and side effects, including wound complications, did not differ between groups.


Combined therapy using CWIS and IV PCA may be a useful strategy for POSP management in gynecologic oncology patients.


Gynecologic neoplasm Local anesthesia Pain management Patient-controlled analgesia Postoperative pain 


Author contributions

BL: Manuscript writing, protocol/project development, data collection, and data analysis. KK: Protocol/project development, data collection, data analysis, and manuscript editing. SA: Data management and data analysis. HJS: Manuscript revising. DHS: Data collection. JHN: Protocol/project development and manuscript revising. YBK: Protocol/project development, data collection, data analysis, and manuscript editing.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was waived.


  1. 1.
    Ferguson SE, Malhotra T, Seshan VE et al (2009) A prospective randomized trial comparing patient-controlled epidural analgesia to patient-controlled intravenous analgesia on postoperative pain control and recovery after major open gynecologic cancer surgery. Gynecol Oncol 114:111–116CrossRefPubMedGoogle Scholar
  2. 2.
    Chung D, Lee YJ, Jo MH et al (2013) The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia. Obstet Gynecol Sci 56:93–101CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Azari L, Santoso JT, Osborne SE (2013) Optimal pain management in total abdominal hysterectomy. Obstet Gynecol Surv 68:215–227CrossRefPubMedGoogle Scholar
  4. 4.
    Chen TF, Clarke N, Bowman R, Harper NJ, Payne SR (1994) Intermuscular bupivacaine infusion for control of pain after renal surgery: a preliminary report. Br J Urol 74:155–159CrossRefPubMedGoogle Scholar
  5. 5.
    Elder JB, Hoh DJ, Wang MY (2008) Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine (Phila Pa 1976) 33:210–218CrossRefGoogle Scholar
  6. 6.
    Mecklem DW, Humphrey MD, Hicks RW (1995) Efficacy of bupivacaine delivered by wound catheter for post-Caesarean section analgesia. Aust N Z J Obstet Gynaecol 35:416–421CrossRefPubMedGoogle Scholar
  7. 7.
    Oderda G (2012) Challenges in the management of acute postsurgical pain. Pharmacotherapy 32:6s–11sCrossRefPubMedGoogle Scholar
  8. 8.
    Forastiere 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 101:841–847CrossRefPubMedGoogle Scholar
  9. 9.
    Fredman B, Shapiro A, Zohar E et al (2000) The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg 91:1436–1440CrossRefPubMedGoogle Scholar
  10. 10.
    Chung F, Ritchie E, Su J (1997) Postoperative pain in ambulatory surgery. Anesth Analg 85:808–816CrossRefPubMedGoogle Scholar
  11. 11.
    Kalkman CJ, Visser K, Moen J, Bonsel GJ, Grobbee DE, Moons KG (2003) Preoperative prediction of severe postoperative pain. Pain 105:415–423CrossRefPubMedGoogle Scholar
  12. 12.
    Schroeder K, Andrei AC, Furlong MJ, Donnelly MJ, Han S, Becker AM (2012) The perioperative effect of increased body mass index on peripheral nerve blockade: an analysis of 528 ultrasound guided interscalene blocks. Rev Bras Anestesiol 62:28–38CrossRefPubMedGoogle Scholar
  13. 13.
    Skinner HB (2004) Multimodal acute pain management. Am J Orthop (Belle Mead NJ) 33:5–9Google Scholar
  14. 14.
    Schumann R, Jones SB, Ortiz VE et al (2005) Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery. Obes Res 13:254–266CrossRefPubMedGoogle Scholar
  15. 15.
    Garimella V, Cellini C (2013) Postoperative pain control. Clin Colon Rectal Surg 26:191–196CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Lewis SS, Moehring RW, Chen LF, Sexton DJ, Anderson DJ (2013) Assessing the relative burden of hospital-acquired infections in a network of community hospitals. Infect Control Hosp Epidemiol 34:1229–1230CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ibrahim MI, Moustafa GF, Al-Hamid AS, Hussein MR (2014) Superficial incisional surgical site infection rate after cesarean section in obese women: a randomized controlled trial of subcuticular versus interrupted skin suturing. Arch Gynecol Obstet 289:981–986CrossRefPubMedGoogle Scholar
  18. 18.
    van Ramshorst GH, Nieuwenhuizen J, Hop WC et al (2010) Abdominal wound dehiscence in adults: development and validation of a risk model. World J Surg 34:20–27CrossRefPubMedGoogle Scholar
  19. 19.
    Blikkendaal MD, Schepers EM, van Zwet EW, Twijnstra AR, Jansen FW (2015) Hysterectomy in very obese and morbidly obese patients: a systematic review with cumulative analysis of comparative studies. Arch Gynecol Obstet 292:723–738CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Hotta K, Inoue S, Taira K, Sata N, Tamai K, Takeuchi M (2016) Comparison of the analgesic effect between continuous wound infiltration and single-injection transversus abdominis plane block after gynecologic laparotomy. J Anesth 30:31–38CrossRefPubMedGoogle Scholar
  21. 21.
    Bertoglio S, Fabiani F, Negri PD et al (2012) The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: a randomized controlled multicenter study. Anesth Analg 115:1442–1450CrossRefPubMedGoogle Scholar
  22. 22.
    Kalogera E, Bakkum-Gamez JN, Weaver AL et al (2016) Abdominal incision injection of liposomal bupivacaine and opioid use after laparotomy for gynecologic malignancies. Obstet Gynecol 128:1009–1017CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  • Banghyun Lee
    • 1
  • Kidong Kim
    • 2
  • Soyeon Ahn
    • 3
  • Hyun-Jung Shin
    • 4
  • Dong Hoon Suh
    • 2
  • Jae Hong No
    • 2
  • Yong Beom Kim
    • 2
    • 5
    Email author
  1. 1.Department of Obstetrics and GynecologyHallym University Kangdong Sacred Heart HospitalSeoulRepublic of Korea
  2. 2.Department of Obstetrics and GynecologySeoul National University Bundang HospitalSeongnam-SiRepublic of Korea
  3. 3.Department of StatisticsSeoul National University Bundang HospitalSeongnam-SiRepublic of Korea
  4. 4.Department of Anesthesiology and Pain MedicineSeoul National University Bundang HospitalSeongnam-SiRepublic of Korea
  5. 5.School of MedicineSeoul National UniversitySeoulRepublic of Korea

Personalised recommendations