Anfänge der kontinuierlichen Wundinfusion mit Lokalanästhetika

Goerig, M.; Gottschalk, Antje

doi:10.1007/s00101-017-0285-5

Cited by 2 publications

(3 citation statements)

References 33 publications

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“…Intuition to irrigate the surgical wound with local anesthetic solutions is due to the research conducted in the early 1900s by Ewald Fulde and Walter Capelle. 1 Subsequently, the two German surgeons focused attention on new methods that allowed both long-term pain control and early postoperative mobilization; developing, in 1930, the first CWI system. 1 Continuous wound infusion is an effective, proven and safe analgesic technique that is simple to perform compared to other analgesic techniques, such as peripheral nerve blocks or epidural analgesia.…”

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confidence: 99%

“…1 Subsequently, the two German surgeons focused attention on new methods that allowed both long-term pain control and early postoperative mobilization; developing, in 1930, the first CWI system. 1 Continuous wound infusion is an effective, proven and safe analgesic technique that is simple to perform compared to other analgesic techniques, such as peripheral nerve blocks or epidural analgesia. 2,3 It consists of an infusion of local anesthetic (LA) into wound through a catheter directly placed by the surgeon at the end of the procedure.…”

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confidence: 99%

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<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patientcontrolled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.

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confidence: 99%

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confidence: 99%

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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“…The first incidence of local anaesthetic solution irrigation at the surgical site was documented in a study done by Ewald Fulde and Walter Capelle in the early 1900s. The first wound infusion system was created in 1930 by two German surgeons who concentrated on establishing innovative techniques that allowed for both long-term pain control and early postoperative mobilization [ 10 ]. Local infiltration and continuous/intermittent infusion of anaesthetics into surgical wounds are now crucial aspects of postoperative pain management due to recent developments in multimodal analgesia [ 11 ].…”

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confidence: 99%

Efficacy of Wound Instillation With Bupivacaine Through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison With Conventional Intravenous Analgesics

Pankaja¹,

Shetty²,

Madhu³

et al. 2023

Cureus

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Introduction A laparotomy can cause severe postoperative pain, which, if treated adequately, can result in reduced incidence of lung atelectasis and ileus promoting early mobilization and faster recovery and in turn reducing the duration of hospital stays. Hence, effective postoperative analgesia is important to reduce postoperative stress and improve early surgical outcomes. Therefore, the hypothesis is based on the fact that following a midline laparotomy, instillation of local anaesthetic agent 0.25% bupivacaine through a wound catheter placed in the subcutaneous plane may provide better analgesia compared to the conventional intravenous analgesics and improve the early surgical outcomes. Methodology A prospective, comparative, quasi-experimental study was conducted on 80 patients planned for emergency or elective midline laparotomy procedures over a period of 18 months, who were randomly distributed into two groups of 40 each. The bupivacaine group consisted of 40 patients who received 10ml of 0.25% bupivacaine instilled through a wound catheter placed in the subcutaneous plane following a midline laparotomy. This was repeated every six hours for the first 24 hours followed by every 12 hours for the next 24 hours. The conventional intravenous (IV) analgesics group involved 40 patients who received conventional IV analgesics routinely used. Pain scores were recorded every four hours for 60 hours using the visual analogue scale (VAS) and dynamic visual analogue scale (DVAS). The parameters assessed were mean VAS and DVAS scores, number of rescue analgesic demands, cumulative rescue analgesic requirement, and early surgical outcomes. Wound complications were also assessed. Results Both groups shared similar demographic characteristics in terms of age, gender, comorbidities, and duration of operation. In comparison to patients who got standard IV analgesics, those who received 0.25% bupivacaine had improved postoperative analgesia. Between the two groups, there were statistically significant results in the number of rescue analgesic demands in the first 24 hours, but in the next 24 hours, it was statistically insignificant. The study also showed that bupivacaine instillation led to a significant decrease in postoperative lung complications and the length of hospital stays; however as hypothesised, it did not improve early surgical outcomes. Conclusion This modality, the instillation of bupivacaine through a wound catheter, is an efficient and technically simple method to provide optimal postoperative analgesia. It substantially reduces the need for systemic analgesics and can potentially avoid their related side effects. Hence, the armamentarium of multimodal analgesia can therefore include this method of delivering postoperative analgesia.

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Anfänge der kontinuierlichen Wundinfusion mit Lokalanästhetika

Cited by 2 publications

References 33 publications

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Efficacy of Wound Instillation With Bupivacaine Through a Wound Catheter for Postoperative Analgesia in Laparotomy Wounds in Comparison With Conventional Intravenous Analgesics

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