In this section
Note: This guideline is currently under review.
Definition of Terms
Assessment of Equipment
Management and Physical Assessment
The ON-Q PainBuster® is an elastomeric pump that contains a reservoir of local anaesthetic (LA) that is infused at a constant and preset rate through a catheter that is fenestrated over 4 lengths depending on the catheter used. The catheter can be placed perineurally (alongside a peripheral nerve) or under a surgical incision (wound catheter).
The use of a continuous LA infusion has been shown to reduce post-operative pain and opioid requirement following surgery and may be used as part of a multimodal analgesia strategy. At the time of surgery a catheter is placed alongside a peripheral nerve or beneath the surgical incision to enable the delivery of LA directly where it is needed. The LA is delivered through an On-Q Soaker Catheter to the On-Q Pain Buster system
Alternatively, LA can be delivered through a wound catheter using a syringe driver colour coded yellow to identify it as regional analgesia. The Alaris syringe drivers are required to be programmed (locked) and the syringe refilled by nursing staff on the ward as indicated in the MAR. The syringe pump is heavy and needs to be fixed to a pole which may inhibit patient mobility and physiotherapy.
The ON-Q PainBuster® system is light and can be carried in a small cloth bag for improved patient mobility
The device is for continuous infusion of LA through a wound catheter in patients who are likely to have pain at the site of surgery eg: bone/cartilage donor sites, lower limb surgery and laparotomy. It is also used for continuous infusion of LA perineurally after upper limb or lower limb surgery where blocking a peripheral nerve’s conduction, is likely to reduce postoperative pain.
Acute management and assessment on return to the ward
Some families are happy to remove the catheter with instructions from CPMS. An information sheet outlining removal will be discussed with the family member who will remove the catheter. The CPMS contact phone number is included on the information sheet.
If a patient is discharged with the catheter in situ and the family do not want to remove the catheter, A HITH referral can be made for families in the HITH catchment area
evidence table for this nursing guideline can be found here.
Photos supplied with permission from the product specialist and trainer for ON-Q
Please remember to
read the disclaimer.
The development of this nursing guideline was coordinated by Sueann Penrose, Clinical Nurse Consultant, Children's Pain management Service, and approved by the Nursing Clinical Effectiveness Committee. Updated June 2020.