Randomized clinical trial of the influence of local subcutaneous infiltration <i>vs</i> subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy

Randall, J.K.; Goede, Anna de; Morgan-Warren, Peter J; Middleton, S B

doi:10.1111/j.1463-1318.2009.01831.x

Cited by 10 publications

(5 citation statements)

References 7 publications

(8 reference statements)

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“…Our study results has been favored by some studies while other studies concluded that infiltration of bupivacaine before incision (pre-emptive) provided better postoperative analgesia than infiltration near closure of wound ( preventive). J K Randall et al found no significant difference in mean pain scores between pre and post incision infiltration of bupivacaine at 1 st , 4 th and 8 th hour post appendectomy similar to our study 11 .…”

Section: Discussionsupporting

confidence: 89%

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

Durrani¹,

Kousar²,

Iqbal³

et al. 2021

PJMHS

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Background: Pain is the most common and most difficult problem faced by patients after operation. Due to inadequate management 30-70% patients suffer from post-operative pain. Acute pain resulting in chronic pain reduces quality of life and creates economic burden. Aim: To compare post-operative pain relief between infiltration of 0.25% bupivacaine into skin and subcutaneous tissue in the line of incision before incision and along edges of wound near completion of procedure. Study design: Randomized control trial Methodology: Sixty four patients were randomly divided into two groups i.e. (0.25% Bupivacaine 6 to 30ml) at the site of incision into skin and subcutaneous tissue Preincision (Group P) and (0.25% Bupivacaine 6 to 30ml) along the edges of wound at near closure of procedure (Group C). Intensity of pain was assessed on visual analogue scale in the recovery room, 3, 6 and 24 hours postoperatively.The time of first dose of rescue analgesia within 24 hours was also noted in both groups. Results: There was no statistically significant difference between two groups regarding age (p-value = 0.324), gender i.e. males (p=0.545) females (p=0.763) and duration of operation (P=Value=0.208). The mean time of rescue analgesia in Group P and Group C in minutes was 318.12±149.47 and 374.84±125.67 respectively (p value =1.5) reflecting no statistically significant difference. Conclusion: Postoperative analgesia and analgesic requirement do not differ significantly whether bupivacaine is infiltrated before incision or just before closure of wound. Keywords: Postoperative pain, bupivacaine, rescue analgesia, Preincision

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Section: Discussionsupporting

confidence: 89%

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

Durrani¹,

Kousar²,

Iqbal³

et al. 2021

PJMHS

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“…Preoperative local wound infiltration into the skin and deep to the external oblique during open appendicectomy showed a relevant reduction in pain intensity; this, together with little to no side effects, enabled its recommendation for open appendicectomies 89,90,93 . Because of a lack of studies on wound infiltration in laparoscopic approaches, there was no evidence to formulate recommendations for this type of surgical procedure.…”

Section: Discussionmentioning

confidence: 99%

“…Seven studies investigated the effect of local wound infiltration, including 532 patients: one study for single-incision laparoscopic appendicectomy in adults; 87 three studies for open appendicectomy in adults, [88][89][90] two studies for open appendicectomy in children 91,92 and one study concerning open appendicectomies in a mixed population. 93…”

Section: Wound Infiltrationmentioning

confidence: 99%

“…Randall et al ’ randomised clinical trial with a mixed population investigated the difference between preoperative local subcutaneous infiltration versus subcutaneous and deep to external oblique infiltration with 2 mg kg −1 bupivacaine 93 . Both groups showed low postoperative pain scores, although the group with deep infiltration had a clinically and statistically significant pain reduction at 24 h. Adequate baseline analgesia was utilised, and no opioid-sparing effect was reported.…”

Section: Regional Analgesia Techniquesmentioning

confidence: 99%

“…Intraperitoneal local anaesthetics during laparoscopic appendicectomy were investigated in seven studies and were mainly positive; thus, they are recommended despite limitations seen in the adult studies not reporting [79][80][81][82][83][84][85] Preoperative local wound infiltration into the skin and deep to the external oblique during open appendicectomy showed a relevant reduction in pain intensity; this, together with little to no side effects, enabled its recommendation for open appendicectomies. 89,90,93 Because of a lack of studies on wound infiltration in laparoscopic approaches, there was no evidence to formulate recommendations for this type of surgical procedure.…”

Section: Surgical Interventionsmentioning

confidence: 99%

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Perioperative pain management for appendicectomy

Freys,

Bigalke,

Mertes

et al. 2024

European Journal of Anaesthesiology

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BACKGROUND Despite being a commonly performed surgical procedure, pain management for appendicectomy is often neglected because of insufficient evidence on the most effective treatment options. OBJECTIVE To provide evidence-based recommendations by assessing the available literature for optimal pain management after appendicectomy. DESIGN AND DATA SOURCES This systematic review-based guideline was conducted according to the PROSPECT methodology. Relevant randomised controlled trials, systematic reviews and meta-analyses in the English language from January 1999 to October 2022 were retrieved from MEDLINE, Embase and Cochrane Databases using PRISMA search protocols. ELIGIBILITY CRITERIA We included studies on adults and children. If articles reported combined data from different surgeries, they had to include specific information about appendicectomies. Studies needed to measure pain intensity using a visual analogue scale (VAS) or a numerical rating scale (NRS). Studies that did not report the precise appendicectomy technique were excluded. RESULTS Out of 1388 studies, 94 met the inclusion criteria. Based on evidence and consensus, the PROSPECT members agreed that basic analgesics [paracetamol and nonsteroidal anti-inflammatory drugs (NSAIDs)] should be administered perioperatively for open and laparoscopic appendicectomies. A laparoscopic approach is preferred because of lower pain scores. Additional recommendations for laparoscopic appendicectomies include a three-port laparoscopic approach and the instillation of intraperitoneal local anaesthetic. For open appendicectomy, a preoperative unilateral transverse abdominis plane (TAP) block is recommended. If not possible, preincisional infiltration with local anaesthetics is an alternative. Opioids should only be used as rescue analgesia. Limited evidence exists for TAP block in laparoscopic appendicectomy, analgesic adjuvants for TAP block, continuous wound infiltration after open appendicectomy and preoperative ketamine and dexamethasone. Recommendations apply to children and adults. CONCLUSION This review identified an optimal analgesic regimen for open and laparoscopic appendicectomy. Further randomised controlled trials should evaluate the use of regional analgesia and wound infiltrations with adequate baseline analgesia, especially during the recommended conventional three-port approach. REGISTRATION The protocol for this study was registered with the PROSPERO database (Registration No. CRD42023387994).

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Pain Management in Liver Transplantation

Weyker

Webb

Mathew

2012

Liver Anesthesiology and Critical Care Medicine

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Randomized clinical trial of the influence of local subcutaneous infiltration vs subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy

Abstract: Both methods of administration of local anaesthetic produced consistently low pain scores in the first 24 h after appendicectomy. There may be additional benefit in a local nerve field blockade in combination with local anaesthetic skin infiltration.

Cited by 10 publications

References 7 publications

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

Postoperative Pain Relief: The Comparison of Bupivacaine before Incision and Near Closure of Wound

Perioperative pain management for appendicectomy

Pain Management in Liver Transplantation

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