Wound infusion with local anaesthesia after laparotomy: a randomized controlled trial

Abstract

Local anaesthesia infusion at the fascial plane provides effective analgesia. This improves patient recovery through earlier return to bowel function and mobilization.

Ropivacaine for Continuous Wound Infusion for Postoperative Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

“…It is interesting to note that the studies by Forastiere et al [21] and Aguirre et al [17] which showed the largest effect sizes for the pain during mobilization and total opioid rescue variables also had two of the highest ropivacaine exposures over the first 24 h (580 and 636 mg, respectively). Contrasting these exposures with those from the studies of Ansaloni et al [23] and Wang et al [19] (260 and 192 mg, respectively) may suggest that the efficacy can be improved for some procedures by using higher ropivacaine exposures. This suggested dose-response relationship is further supported by the results of the study by Gottschalk et al [22], which demonstrated that an infusion rate of 18.75 mg/h significantly reduced pain at rest and during mobilization compared to a rate of 10 mg/h.…”

“…Another patient developed a transient ischaemic attack about 48 h after open hepatic surgery [28]. In another study [19], 1 control group patient had her morphine PCA terminated around 24 h after surgery due to excessive confusion and sedation. Across all included studies, there were no reports or signs of local anaesthetic systemic toxicity with all reported ropivacaine plasma concentrations below toxic levels.…”

“…4 Forest plot of total opioid rescue medication effect size estimates from published CWI studies of ropivacaine versus placebo [17,19,20,21,22,28,33,34,35,39]. A negative effect size indicates reduced use of opioids in ropivacaine-treated patients as compared to placebo-treated patients.…”

“…Except for 2 studies [19,20], an active ropivacaine bolus dose was provided prior to initiation of the ropivacaine infusion. In 1 study [21], this ropivacaine bolus dose was given to both treatment groups prior to initiation of the randomized wound infusion [21].…”

“…Five of the studies [22,24,25,33,34] included in the current meta-analysis were also included by Liu et al [1]. In addition, the current meta-analysis includes data from 8 new studies [12,17,19,21,23,26,28,35] published after 2006 and the study by Stewart et al [20] that was omitted by Liu et al While Liu et al did not perform separate meta-analyses for ropivacaine and bupivacaine, our results confirm that ropivacaine CWI is an effective postoperative analgesic regimen, with clinically meaningful reductions in opioid use and pain outcomes.…”