A qualitative systematic review of incisional local anaesthesia for postoperative pain relief after abdominal operations

Abstract

In a qualitative systematic review, we have evaluated randomized controlled trials (RCT) of incisional local anaesthesia compared with placebo or no treatment in the control of postoperative pain after open abdominal operations. Twenty-six studies with data from 1211 patients were considered appropriate for analysis. Five RCT considered inguinal herniotomy, four hysterectomy, eight cholecystectomy and nine studies a variety of surgical procedures. Outcome measures were pain scores, supplementary analgesics and time to first analgesic request. Efficacy was estimated by significant difference (P < 0.05), as reported in the original investigation. All studies of herniotomy showed a 2-7-h duration of clinically relevant improved pain relief. Results of hysterectomy studies were inconclusive, with two being negative. Five of the cholecystectomy studies showed significant differences but questionable clinical importance and validity in three. In various other procedures results were inconsistent and in some of minor clinical importance. Except for herniotomy, there was a lack of evidence for effect of incisional local anaesthesia on postoperative pain and further standardized studies are needed before recommendations can be made.

Assessment of postoperative analgesia after intraperitoneal instillation of lornoxicam in laparoscopic appendectomy: a randomized study

“…Postoperative pain, however, does not completely disappear after laparoscopic surgeries and, in the early postoperative period, severe pain and nausea may occur and a strong analgesia may be necessary. [5][6][7] In the presents study distribution of patients based on demographic characteristics including age and sex were comparable in both the groups. Further, both the groups did not differ significantly with regard to clinical presentation and preoperative evaluation for vitals.…”

Operacinių žaizdų infiltracija vietiniais anestetikais – pritaikymas ir nauda

“…infuzija, skausmas buvo žymiai mažesnis ir papildomo nuskausminimo poreikis buvo 50 proc. mažesnis pirmą ir antrą parą po operacijos (P<0,05) [24]. 2008m.…”

“…Buvo sutaupyta apie 273 eurai kiekvienam pacientui, gavusiam nuolatinę infuziją vietiniais anestetikais [11]. Kol kas svari žaizdų infiltracijos anestetikais nauda stebima po kirkšninės iš-varžos operacijų [4, 15,24]. Po kitų abdominalinių operacijų šio nuskausminimo naudai įrodyti ir rekomendacijoms sukurti reikia atlikti daugiau tyrimų, kuriuose būtų įvertinami ir finansiniai aspektai [7,16,29] .…”

Transversus Abdominis Plane (Tap) Block Versus Local Anesthetic Wound Infiltration (Lwi) for Post Total Abdominal Hysterectomy (Tah) Pain Relief.

“…Several strategies to control somatic component of post TAH pain have been trialed including transversus abdominis plane (TAP) block and local anesthetic wound infiltration (LWI) (7,8,9,10,11) .…”

“…Single shot or continuous infiltration of local anesthetic into surgical wound has been trailed with varying degree of efficacy in postoperative analgesia after TAH (8,9,10,11) .…”