Wound catheters for post‐operative pain management: overture or finale?

Rawal, Narinder; Borgeat, A.; Scott, N. B.

doi:10.1111/j.1399-6576.2011.02597.x

Cited by 8 publications

(4 citation statements)

References 9 publications

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“…60 A more recent meta-analysis and accompanying editorial were far less positive, 63,64 but these conclusions were most likely due to the exclusion of orthopedic patients and patients in whom catheters were not actually in the surgical wound. 65,66 In clinical practice, wound catheter infusion techniques include catheters placed through the incision into deeper layers or cavities, for example, subfascial, peritoneal, subacromial, intraosseous, and intra-articular placement. 65,67 The importance of appropriate catheter positioning was demonstrated in a study of patients undergoing open colorectal surgery.…”

Section: Wound Catheter Infusionmentioning

confidence: 99%

“…65,66 In clinical practice, wound catheter infusion techniques include catheters placed through the incision into deeper layers or cavities, for example, subfascial, peritoneal, subacromial, intraosseous, and intra-articular placement. 65,67 The importance of appropriate catheter positioning was demonstrated in a study of patients undergoing open colorectal surgery. Wound infusion through a catheter placed preperitoneally was associated with effective analgesia for up to 72 hours, decreased opioid consumption, earlier recovery of bowel function, and a hospital stay shorter by 30 hours.…”

Section: Wound Catheter Infusionmentioning

confidence: 99%

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Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

223

136

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Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only. There is increasing evidence that less invasive regional analgesic techniques are as effective as epidural analgesia. These include paravertebral block for thoracotomy, femoral block for total hip and knee arthroplasty, wound catheter infusions for cesarean delivery, and local infiltration analgesia techniques for lower limb joint arthroplasty. Wound infiltration techniques and their modifications are simple and safe alternatives for a variety of other surgical procedures. Although pain relief associated with epidural analgesia can be outstanding, clinicians expect more from this invasive, high-cost, labour-intensive technique. The number of indications for the use of epidural analgesia seems to be decreasing for a variety of reasons. The decision about whether to continue using epidural techniques should be guided by regular institutional audits and careful risk-benefit assessment rather than by tradition. For routine postoperative analgesia, epidural analgesia may no longer be considered the gold standard.

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Section: Wound Catheter Infusionmentioning

confidence: 99%

Section: Wound Catheter Infusionmentioning

confidence: 99%

Epidural Technique for Postoperative Pain

Rawal

2012

Regional Anesthesia and Pain Medicine

223

136

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“…In contrast, local anaesthetic infiltration techniques may reduce the risk of severe complications, and the side‐effect burden of opioid‐based analgesia. As such, a direct comparison of local anaesthetic wound infiltration versus epidural analgesia is warranted.…”

Section: Introductionmentioning

confidence: 99%

Systematic review and meta-analysis of continuous local anaesthetic wound infiltrationversusepidural analgesia for postoperative pain following abdominal surgery

Ventham

Hughes

O’Neill

et al. 2013

British Journal of Surgery

127

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“…No significant differences in side effects were found, except for a lower risk of wound breakdown (P=0.048) and a shorter length of hospital stay (P=0.04) in patients receiving LA. Some authors disagree about these results arguing that these conclusions were due to the exclusion of orthopaedic patients and patients in whom catheters were not actually placed in the surgical wound [92].…”

Section: Peri-incisional Analgesiamentioning

confidence: 99%