A 96‐hour continuous wound infiltration with ropivacaine reduces analgesic consumption after liver resection: A randomized, double‐blind, controlled trial

Abstract

Background: Continuous wound infiltration (CWI) with local anesthetics to reduce morphine consumption in postoperative pain management after open liver resection in patients with cancer.Methods: This single-center randomized double-blind study allocated patients requiring resection of liver metastases to receive a 3.75 mg/mL ropivacaine (ROP) infiltration, followed by a 2 mg/mL ROP CWI, or placebo (P) for 96 hours.Postoperative analgesia included acetaminophen and patient-controlled analgesia morphine pump. The primary endpoint was to investigate the reduction of total morphine consumption (mg/kg) over the first 96 postoperative hours.Results: Eighty-five patients were recruited, and randomized (ROP: 42, P: 43) between 2009 and 2014. The median morphine consumption significantly decreased in the ROP arm in the first 96 postoperative hours (ROP: 1.0, P: 1.5 mg/kg; P = 0.026).Twenty-three (27%) patients had grade 3 adverse events (ROP: 14, P: 9) and four experienced grade 3 treatment-related adverse events (ROP: mental confusion [n = 1], hallucinations [n = 2], P: hematoma [n = 1]). Two (5%) patients showed a wound inflammation (ROP: 1, P: 1). Nine (11%) patients experienced at least one serious adverse event (ROP: 6, P: 3); none related to treatment.Conclusion: Preperitoneal CWI of 2 mg/mL ROP significantly reduces intravenous morphine consumption during the 96 postoperative hours resulting in an absolute reduction of 0.5 mg/kg.

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

“…Compared to placebo, both continuous and single-shot ropivacaine WI resulted in lower pain scores, reduced opioid consumption, reduced stress hormones levels, shorter LOS, and faster bowel recovery after open hepatectomy [158][159][160]. CWI showed equivalent efficacy as epidural PCA and opioid intravenous analgesia after open hepatectomy [161,162].…”

Comparison of the Effects of Ultrasound-guided Erector Spinae Plane Block and Wound Infiltration on Perioperative Opioid Consumption and Postoperative Pain in Thoracotomy

“…5 Wound infiltration with local anesthetics is a very simple and effective local analgesic technique. 7,8 As a previous randomised trial reported, wound infiltration with ropivacaine could significantly reduce postoperative pain and postoperative analgesic consumptions in thoracotomy. 9 To the authors' best knowledge, until now, no randomised, controlled, clinical study has been conducted to compare the effects of preoperative ultrasound-guided ESPB and wound infiltration with local anesthetics on perioperative opioid consumption and postoperative pain in thoracotomy.…”

Pain management after open liver resection: Procedure-Specific Postoperative Pain Management (PROSPECT) recommendations

“…Another similar study found that local anesthetic infusion through a subfascial catheter reduced opioid use but did not influence pain scores. 26 Basic analgesia consisted of acetaminophen and nefopam. 26 Yet another placebo-controlled RCT reported that local anesthetic infusion through two catheters placed-one in the subfascial plane and the other subcutaneously-resulted in significantly lower pain scores at rest at 8 and 16 hours but no difference on pain associated with movement.…”

“…26 Basic analgesia consisted of acetaminophen and nefopam. 26 Yet another placebo-controlled RCT reported that local anesthetic infusion through two catheters placed-one in the subfascial plane and the other subcutaneously-resulted in significantly lower pain scores at rest at 8 and 16 hours but no difference on pain associated with movement. 27 The use of basic analgesics was not reported.…”