Continuous Ropivacaine Infusion Offers No Benefit in Treating Postoperative Pain After Cardiac Surgery

Opioid-Sparing Analgesia for Sternotomy: Do Surgical Site Continuous Local Anesthetics Actually Work?

“…Several regional anesthetic techniques, including chest wall nerve blocks and continuous infusions of local anesthetic (LA) into the sternal wound, have shown some potential to improve pain with normal breathing or deep breathing and movement. 4 The article by Florkiewicz et al 5 reports on one of the studies assessing whether LA infusions reduce postoperative pain. Numerous studies have assessed the use of different non-opioid drugs to reduce opioid administration and control pain.…”

“…This same concept and technology using PAINfusion catheters (PAINfusor Catheter 30, Baxter Corporation, Helsinki, Finland) and elastomeric pumps to directly infuse LAs into the sternal wound was used in the study by Florkiewicz et al 5 These authors found that a continuous 0.2% ropivacaine infusion offered no difference or benefit in opioid consumption or postoperative pain versus a placebo. They presented supporting studies in which a 0.2% ropivacaine solution infused into the sternal wound of children offered no benefit in opioid consumption or pain after surgery.…”

Effectiveness of wound infusion of 0.2% ropivacaine by patient control analgesia pump after minithoracotomy aortic valve replacement: a randomized, double-blind, placebo-controlled trial

“…This may lead to a less effective analgesia at the surgical wound, even more so when using longer wound catheters. Not least, some authors have reported cases of local anesthetic leaking back through the insertion point of the wound catheter [ 29 ], and there are also reports where local anesthetic wound infusion was of no benefit after full sternotomy [ 20 , 29 , 30 ]. The length of the wound catheter that has to be used in these patients combined with a delivery system without pressure alarm, may play a role.…”

Enhanced Recovery After Surgery for Cardiac Surgery: Will We Have the Techniques Needed to Reduce Opioid Use and Still Provide Appropriate Analgesia?

“…These techniques classically have involved local anesthetic (LA) infiltration; neuraxial techniques using thoracic epidural anesthesia (TEA); intrathecal morphine injection; and, as recently reported in this journal, the use of continuous ropivacaine infusion into the sternotomy wound using a multiorifice catheter with an elastomeric pump. 1 Other regional techniques used to provide analgesia to the chest wall could reduce pain and opioid requirements, in turn allowing for better chest wall mechanics, reduced atelectasis, and improved pulmonary function. 2 Mittnacht et al 3 described the types of chest wall pain that occur after cardiac surgery, the innervation of the chest wall that elicits the pain, and the regional techniques appropriate to block the nerves damaged by the incision and surgical approach.…”

“…The practice of continuous LA infusion into the wound has been shown to be beneficial in some studies 11 and of no benefit in others. 1 However, the results of some of these studies are suspect because variations in catheter placement, along with dosing techniques and catheter position, may be the reason for the differences in results observed. In addition, the pump continuously infuses LA agents and depending on the concentration used, fairly high serum levels can be noted with effective analgesia.…”