In-wound drugs work wonders on post-surgery pain

WASHINGTON — The first time Kathy Kennedy gave birth via a Caesarean section, the wound was so painful she could barely hobble out of bed despite taking the powerful narcotic Percocet. But after her second C-section, "I popped out of bed."

The reason: a balloon-like gadget dripped a numbing drug below her stitches directly into the wound, without the grogginess and other body-wide effects of narcotics.

In-the-wound painkillers are a growing trend among surgeons trying out the technique for everything from heart bypass operations to knee replacement — although just how well the $200-plus method really works isn't yet proven.

"It makes sense," says Dr. Michael Schurr of the University of Wisconsin, who is conducting what may be the strictest study yet of the method, in 80 hernia patients. "The whole question is if the cost is worth the reduction in pain."

But there is some promising early research: In a study of 35 heart-bypass patients to be published next month, Dr. Robert Dowling of Jewish Hospital in Louisville, Ky., found those who had the device drip a numbing drug onto their stitched-up breastbone left the hospital three days sooner than patients given a saltwater drip. A similar University of Tennessee comparison of 36 C-section patients found a 40 percent reduction in narcotic use.

In-the-wound painkillers are part of a bigger movement to improve a dismal problem: Up to 60 percent of post-surgery pain is undertreated.

Pain actually delays recovery. It stresses the immune system and hinders movement — a particular problem when optimal healing depends on quick physical therapy.

Worse, uncontrolled pain right after surgery increases a patient's risk of developing chronic pain problems months later, warns University of Wisconsin professor June Dahl, a well-known pain specialist. Somehow, acute pain sets up nerve pathways that leave patients vulnerable.

Narcotic painkillers are a mainstay, but they can cause their own problems, including grogginess and constipation, that can delay hospital discharge. Nor are they always enough.

A better approach is called "multi-modal therapy," using an array of drugs that attack pain through different methods, thus decreasing narcotic use, Dahl says. But she recently studied 235 hospitals and found that new approach isn't used widely enough. In fact, a surprising quarter of hospitals still gave intramuscular pain injections, a slow-relief method not usually recommended.