Local anesthetic delivery systems like PainComforter and ON-Q Pump are effective in reducing opioid use, enhancing recovery, and promoting early ambulation post-surgery. However, their cost can be prohibitive. This innovation proposes the use of angiocatheter, a widely accessible and cost-effective urological instrument, as an alternative to PainComforter, priced at USD12 per piece, while maintaining similar clinical efficacy.

The aim is to assess the efficacy of angiocatheter-based local anesthetic delivery in achieving pain management outcomes comparable to PainComforter. This involves using an angiocatheter with fenestrations spaced 1 cm apart, tailored to the wound's length. The preliminary application was conducted on patients undergoing open nephrectomy via subcostal flank incision, utilizing a Transversus Abdominis Plane (TAP) nerve blockade. Ropivacaine 0.1% was administered, starting with an initial bolus of 40 mg, followed by a titratable infusion rate up to 8 ml/hour, with a maximum cumulative dose of 675 mg, in accordance with local guidelines.

Initial results demonstrate that the angiocatheter effectively reduces opioid usage, with infusion required for only 2-3 days postoperatively, supplemented by non-opioid oral analgesia. The approach is well-tolerated with minimal adverse effects. Local complications included infection, catheter migration, blockage, and temporary nerve injury. Systemic complications, though rare at 0.03%, included perioral numbness, tinnitus, agitation, seizures, cardiovascular effects, and confusion.

The angiocatheter is a viable, cost-effective alternative to PainComforter for local anesthetic delivery, maintaining efficacy in reducing opioid use and enhancing recovery. Further research with larger sample sizes is warranted to validate these findings and optimize the technique for broader clinical application.