Postoperative analgesia with continuous wound infusion of local anaesthesia <i>vs</i> saline: a double‐blind randomized, controlled trial in colorectal surgery

Fustran, N.; Dalmau, A.; Ferreres, E.; Camprubí, I.; Sanzol, R.; Redondo, Susana; Kreisler, Esther; Biondo, Sebastiano; Sabaté, Antoni

doi:10.1111/codi.12893

Cited by 29 publications

(24 citation statements)

References 27 publications

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“…Chan et al [ 10 ] showed that continuous wound infusion with ropivacaine reduced morphine consumption and pain scores in patients who underwent open hepatic surgery. In addition, a previous study involving colorectal surgery noted similar results [ 18 ]. In contrast, Polglase et al [ 1 ] reported that ropivacaine wound infusion provided no clinical advantage for patients undergoing open colorectal surgery.…”

Section: Discussionsupporting

confidence: 67%

Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

Park

Koo

et al. 2016

Ann Surg Treat Res

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PurposeLocal anesthetic wound infusion has been previously investigated in postoperative pain management. However, a limited number of studies have evaluated its use in laparoscopic colorectal surgery. This study aims to evaluate whether ropivacaine wound infusion is effective for postoperative pain management after laparoscopic surgery in patients with colorectal cancer.MethodsThis prospective study included 184 patients who underwent laparoscopic surgery for colorectal cancer between July 2012 and June 2013. The patients were grouped as the combined group (intravenous patient-controlled analgesia [IV-PCA] plus continuous wound infusion with ropivacaine, n = 92) and the PCA group (IV-PCA only, n = 92). Efficacy and safety were assessed in terms of numeric rating scale (NRS) pain score, opioid consumption, postoperative recovery, and complications.ResultsThe total quantity of PCA fentanyl was significantly less in the combined group than in the PCA group (P < 0.001). The NRS score of the combined group was not higher than in the PCA group, despite less opioid consumption. There were no differences between groups for postoperative recovery and most complications, including wound complications. However, the rate of nausea and vomiting was significantly lower in the combined group (P = 0.022).ConclusionRopivacaine wound infusion significantly reduced postoperative opioid requirements and the rate of nausea/vomiting. This study showed clinical efficacy of ropivacaine wound infusion for postoperative pain control in colorectal cancer patients undergoing laparoscopic surgery.

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Section: Discussionsupporting

confidence: 67%

Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

Park

Koo

et al. 2016

Ann Surg Treat Res

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“…[59][60][61][63][64][65]67,69,71 Similar to what has been demonstrated for open abdominal surgery, also in this case, CWI has demonstrated its effectiveness in the postoperative pain control, parental opioid consumption, rate of nausea/vomiting, early mobilization, bowel and pulmonary function; both when this technique has been compared with systemic or epidural analgesia. 61,63,64,67,69,71 Furthermore, it would appear that continuous wound infusion with LA could also affect stress response and immunomodulation. 59,65 However, further studies are needed to elucidate this aspect.…”

Section: Lower Limb Surgerysupporting

confidence: 74%

“…[43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58] Regarding laparoscopic surgery, among 13 articles retrieved [59][60][61][62][63][64][65][66][67][68][69][70][71] most were related to laparoscopic colorectal surgery (9 out of 13). [59][60][61][63][64][65]67,69,71 Similar to what has been demonstrated for open abdominal surgery, also in this case, CWI has demonstrated its effectiveness in the postoperative pain control, parental opioid consumption, rate of nausea/vomiting, early mobilization, bowel and pulmonary function; both when this technique has been compared with systemic or epidural analgesia. 61,63,64,67,69,71 Furthermore, it would appear that continuous wound infusion with LA could also affect stress response and immunomodulation.…”

Section: Lower Limb Surgerymentioning

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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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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“…Using a ropivacaine infusion postoperatively as a pain control is successful in reducing pain as long as the infusion continues. 17 When ropivacaine was dosed locally without infusion, the duration of activity lasted only for the first few hours post surgery. 18 …”

Section: Discussionmentioning

confidence: 99%

The effect of local/topical analgesics on incisional pain in a pig model

Castel¹,

Sabbag²,

Meilin³

2017

JPR

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Interest in the development of new topical/local drug administration for blocking pain at peripheral sites, with maximum drug activity and minimal systemic effects, is on the rise. In the review article by Kopsky and Stahl, four critical barriers in the process of research and development of topical analgesics were indicated. The active pharmaceutical ingredient (API) and the formulation are among the major challenges. The road to the development of such drugs passes through preclinical studies. These studies, if planned correctly, should serve as guidance for choosing the right API and formulation. Although rodent models for pain continue to provide valuable data on the mechanisms driving pain, their use in developing topical and localized treatment approaches is limited for technical (intraplate injection area is small) as well as mechanical reasons (non-similarity to human skin and innervation). It has been previously shown that pigs are comparable to humans in ways that make them a better choice for evaluating topical and local analgesics. The aim of this study was to summarize several experiments that used pigs for testing postoperative pain in an incisional pain model (skin incision [SI] and skin and muscle incision [SMI]). At the end of the surgery, the animals were treated with different doses of bupivacaine solution (Marcaine®), bupivacaine liposomal formulation (Exparel®) or ropivacaine solution (Naropin). Von Frey testing demonstrated a decrease in the animals’ sensitivity to mechanical stimulation expressed as an increase in the withdrawal force following local treatment. These changes reflect the clinical condition in the level as well as in the duration of the response. These data indicate a good resemblance between pig and human skin and suggest that use of these animals in the preclinical phase of developing topical analgesics can, to some extent, release the bottleneck.

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Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double‐blind randomized, controlled trial in colorectal surgery

Abstract: Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.

Cited by 29 publications

References 27 publications

Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

Analgesic efficacy of ropivacaine wound infusion after laparoscopic colorectal surgery

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

The effect of local/topical analgesics on incisional pain in a pig model

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