Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults

Liang, Simon; Ying, Andrew; Affan, Eshan T.; Kakala, Benedict; Strippoli, Giovanni F.M.; Bullingham, Alan; Currow, Helen; Dunn, David W.; Yeh, Zeigfeld Yu-Ting

doi:10.1002/14651858.cd012310.pub2

Cited by 24 publications

(14 citation statements)

References 77 publications

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“…Baseline demographics, perioperative data, and surgical data (Table 3 ) were extracted from the patient’s medical record and from a prospectively maintained database, the ERAS ® Interactive Audit System (EIAS) [ 15 ]. Analgesia and pain were estimated using the numeric rating scale (NRS) of 0–10 [ 16 ] before and after each mobilization session [ 17 ]. Opioid consumption, PONV, and blood pressure management were also recorded.…”

Section: Definitionsmentioning

confidence: 99%

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

et al. 2021

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Background Early mobilization is a significant part of the ERAS® Society guidelines, in which patients are recommended to spend 2 h out of bed on the day of surgery. However, it is not yet known how early patients can safely be mobilized after completion of colorectal surgery. The aim of this study was to evaluate the feasibility, and safety of providing almost immediate structured supervised mobilization starting 30 min post-surgery at the postoperative anesthesia care unit (PACU), and to describe reactions to this approach. Methods This feasibility study includes 42 patients aged ≥18 years who received elective colorectal surgery at Örebro University Hospital. They underwent a structured mobilization performed by a specialized physiotherapist using a modified Surgical ICU Optimal Mobilization Score (SOMS). SOMS determines the level of mobilization at four levels from no activity to ambulating. Mobilization was considered successful at SOMS ≥ 2, corresponding to sitting on the edge of the bed as a proxy of sitting in a chair due to lack of space. Results In all, 71% (n = 30) of the patients reached their highest level of mobilization between the second and third hour of arrival in the PACU. Before discharge to the ward, 43% (n = 18) could stand at the edge of the bed and 38% (n = 16) could ambulate. Symptoms that delayed advancement of mobilization were pain, somnolence, hypotension, nausea, and patient refusal. No serious adverse events occurred. Conclusions Supervised mobilization is feasible and can safely be initiated in the immediate postoperative care after colorectal surgery. Trial registration Clinical trials.gov identifier: NTC03357497.

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Section: Definitionsmentioning

confidence: 99%

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

et al. 2021

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“…LAWICs postlaparotomy have demonstrated superiority to placebo or non-inferiority to an epidural infusion in association with colorectal surgery,3–6 hepatobiliary surgery,7 gastric surgery,8 renal transplant9 and nephrectomy 10. A recent Cochrane meta-analysis of LAWICs use in elective colorectal surgery demonstrated moderate to strong evidence that they significantly reduce postoperative pain at rest, length of stay and opioid consumption and also may reduce pain on movement 11…”

Section: Introductionmentioning

confidence: 99%

A retrospective cohort study of three wound catheter infusion analgesia regimes after midline laparotomy

Perry

Bullingham

2022

Reg Anesth Pain Med

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BackgroundLocal anesthetic wound infusion catheters are increasingly used postmidline laparotomy to reduce pain and opioid use, however there is little evidence to support any particular infusion regime.MethodsA retrospective cohort study was undertaken of patients after midline laparotomy who had bilateral local anesthetic wound infusion catheters surgically placed. Patients were recruited into 3 cohorts: ropivacaine 0.2% 5–8 mL/hour continuous wound infusion, 10 mL programmed intermittent bolus 2 hourly, 20 mL programmed intermittent bolus 4 hourly. The primary outcome was the maximum daily Numerical Rating Pain Score with movement (dynamic pain score) recorded during first 96 hours postprocedure. Secondary outcomes included the maximum daily resting pain score and opioid utilization.ResultsIn three cohorts of 70 patients (n=210), the maximum daily dynamic pain score in the intermittent bolus 2-hourly and 4-hourly cohorts was lower when compared with the continuous infusion group over the first 4 postoperative days. The mean difference in maximum daily pain score with respect to the continuous infusion regime was 0.8 (95% CI 0.2 to 1.4) for the intermittent bolus 2-hourly group and 0.6 (95% CI 0.0 to 1.2) for the 4-hourly group. Generalized estimating equation modeling indicates the reduction in dynamic pain score is greatest with the intermittent bolus 2-hourly regime over the first 72 hours postprocedure. The 2-hourly intermittent bolus regime was also associated with lower opioid utilization and local anesthetic exposure.ConclusionsIntermittent wound infusion catheter infusion regimes were associated with lower maximum daily dynamic pain scores, although the magnitude of this change may be of limited clinical significance.

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“…[ 3 ] Although there were many English literatures reporting on acceptable efficacy of preperitoneal analgesia (PPA),[ 2 4 ] there were minimal number of studies that reported otherwise. [ 5 6 ] As the delivery devices for continuous infusion at wound comes with additional costs and previous study by Huei et al . [ 3 ] had a rather low sample size which did not include a comparison arm; this study is improvised to examine the efficacy of preperitoneal infusion for pain control following elective colorectal surgery.…”

Section: Introductionmentioning

confidence: 99%

Comparison of continuous preperitoneal infiltration versus patient controlled analgesia for pain control in elective colorectal surgery

Hwee

Zhe

Huei

et al. 2022

Saudi Journal of Anaesthesia

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Background: Post-operative analgesia is crucial in enhanced recovery after surgery and to minimize post-operative complications. There remains data paucity on the efficacy of preperitoneal analgesia (PPA) compared to patient-controlled analgesia (PCA). This study aims to examine the efficacy of preperitoneal infusion as analgesia following elective colorectal surgery. Methods: This is a prospective cross-sectional study of all patients which underwent elective colorectal surgeries, performed in a tertiary surgical referral center with dedicated colorectal unit. Patients from May 2017 to April 2021 who underwent elective colorectal surgery were included in this study. Pain scores were reviewed and analyzed at regular intervals post-operatively for comparison. Results: Amongst the 200 patients included, there were 174 patients in the PPA arm and 26 patients using PCA. Patients in the PPA group were older age (63.29 vs 56.00, P = 0.003). A total of 118 patients in PPA cohort (67.8%) and 21 from PCA cohort (80.8%) underwent open surgery and the remaining 82 patients underwent laparoscopic surgeries. Although postoperative pain scores were consistently below 5 and reduced in trend from 2 hours to 96 hours postoperatively in both groups, the pain scores on coughing markedly reduced in the PPA group when compared PCA alone. The total dosage of opioid required in PPA cohort was also significantly lower when compared to PCA group at the first 24 hours postoperatively 12.21 (±13.0) vs 20.0 (±14.43), P = 0.048. Conclusions: PPA is a comparable modality for analgesia after elective colorectal surgery that reduces the opioid requirement postoperatively giving adequate pain relief. PPA should be considered as an alternative modality for multi-modal analgesia.

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Continuous local anaesthetic wound infusion for postoperative pain after midline laparotomy for colorectal resection in adults

Cited by 24 publications

References 77 publications

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

Supervised Immediate Postoperative Mobilization After Elective Colorectal Surgery: A Feasibility Study

A retrospective cohort study of three wound catheter infusion analgesia regimes after midline laparotomy

Comparison of continuous preperitoneal infiltration versus patient controlled analgesia for pain control in elective colorectal surgery

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