Continuous coeliac plexus blockade plus intermittent wound infiltration with bupivacaine following upper abdominal surgery: a double‐blind randomised study

Abstract

In this double-blind trial, we observed the effect of intermittent wound infiltration with local anaesthetic plus continuous coeliac plexus blockade on postoperative pain relief, pulmonary function, the neuroendocrine and acute phase protein response following upper abdominal surgery. In Group A (n = 10) patients received bupivacaine intermittently into the wound and continuously into the coeliac plexus following an initial bolus. A total of 862.5 mg of bupivacaine was used over 12 h with no observed toxicity. Group B (n = 10) received equal volumes of saline. Although pain relief was poor in both groups, the bupivacaine group used less morphine postoperatively and had lower pain scores than the saline group 4 h after operation (P less than 0.05). Pulmonary function was significantly reduced in both groups with no statistical difference between the two. Significant reductions in serum glucose and cortisol were achieved (P less than 0.05), suggesting that afferent neural blockade was partially effective in attenuating the neuroendocrine response. However, the postoperative rise in interleukin-6 was not affected by this technique. It is concluded that total afferent neural blockade cannot be achieved with peripheral wound and coeliac plexus administration of relatively large doses of local anaesthetic during upper abdominal surgery.

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

“…CWI with ropivacaine may also act through systemic reabsorption by local vascularization . Even if it remains speculative, we assume that there may be a link between the reduction of postoperative morphine consumption and the plexus coeliac blockade with local anesthetics as previously reported . A blockade of coeliac plexus in hepatic procedure led to a reduction of morphine consumption.…”

“…A blockade of coeliac plexus in hepatic procedure led to a reduction of morphine consumption. Surgery with local infiltration allows to reduce morphine consumption and lower pain scores are reported after surgery . More recent studies also reported the reduction of morphine consumption in patients with liver metastasis and less pain experienced in hepatic arterial embolization, thermoablation of liver metastases, and hepatic refractory pain …”

Wound infiltration for surgery

“…Hamid et al. [29] demonstrated that pain relief and pulmonary function were poor even with combined wound and coeliac plexus catheters, presumably because total afferent neural blockade cannot be achieved. Intermittent bupivacaine into the rectus sheath after midline laparotomy does not decrease opioid requirement, postoperative pain or peak expiratory flow rate [30].…”

Development and verification of saphenous, tibial and common peroneal nerve block techniques for analgesia below the thigh in the nonchondrodystrophoid dog

“…head, thoracic, or abdominal trauma patients and those unable to tolerate systemic analgesics (Brennan 1993). These uses have been modified to include indwelling catheter delivery of local anesthetic nerve blocks via constant rate infusions, intermittent ‘top‐up’, or patient‐controlled mechanisms (Hamid et al. 1992; Mackenzie & Pullinger 1997; Klein et al.…”