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New Method of Flexor Tenosynovitis Treatment Results in Less Post-operative Pain and Earlier Range of Motion
Haritha B. Veeramachaneni, MD; Brad Edgerton
Plastic and Reconstructive Surgery, University of Southern California, Los Angeles , CA

Introduction: We present our recent experience adopting the use of ON-Q pump catheters to treat infectious flexor tenosynovitis in two patients. They have experienced improved, and earlier range of motion in addition to no pain with this method compared to our previous methods of treatment.

Methods: A retrospective review over the past 5 years of all flexor tenosynovitis operations at our institution yielded three cases treated with operative drainage and placement of a penrose drain. These patients were compared to the patients treated with drainage and placement of an ON-Q catheter within the tendon sheath that was left in place on average of 5 days until the Marcaine release was complete.  Hospital stay, post-operative pain scores, post-operative intravenous pain medication usage, occupational therapy assessments, and post-operative range of motion were assessed for each patient.

Results: All patients stayed in the hospital on average 3 days after surgery before discharge home. None of the patients experienced infection recurrence. Post-operative pain was significantly reduced in the ON-Q catheter group. On average the post-operative pain scores throughout the hospital stay were 6.7 in the penrose drain group compared to 0 in the ON-Q group.  On average the penrose group required 2-6 mg of IV morphine given twice daily in addition to oral narcotics, whereas the ON-Q group required no intravenous pain medication and minimal oral narcotics during their stay.  In the month following surgery, the On-Q group had on average 20-30 degrees greater range of motion at the MCP and IP joints than the penrose group.

Conclusions: Although other studies have not shown much benefit with minimal incision catheter drainage compared to open irrigation and drainage for flexor tenosynovitis, we propose that this is because previously described irrigation methods use plain or antibiotic irrigation and not the anesthetic irrigation used in our patients. In our experience thus far, this method eliminates post-operative pain and therefore allows for earlier range of motion. We plan to continue using the ON-Q in future patients and assessing this trend with greater numbers.

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