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Page 10 of 13 Gharagozloo. Mini-invasive Surg 2020;4:8 I http://dx.doi.org/10.20517/2574-1225.2019.62

Figure 4. Five-inch on-Q soaker catheters

A B C

D E

Figure 5. (A-E) Steps for the placement of subpleural catheters for local infiltration of local anesthetic for 10 days in the ambulatory
setting

the infusion over multiple areas [Figures 4-6]. With the on-Q system, flow rate and duration are dependent
upon the model used, and can range from 0.5 to 10 mL/h with a reservoir volume of 65-400 mL. For robotic
thoracic surgery applications, we use two catheters, an infusion of approximately 4 mL/h (2 mL per catheter)
with a 400 mL reservoir and 0.125 bupivacaine. This system is used after the patient is discharged from
the hospital, giving the patient 10 days of local pain control. In our institution, intercostal nerve blockade
by infusion of a local anesthetic via a subpleural catheter has been shown to be an effective alternative to
epidural catheters and cryoanalgesia. This technique provides excellent prolonged pain control after robotic
[36]
thoracic surgery while decreasing the need for narcotics [Table 1] .