Continuous wound infusion and local infiltration analgesia for postoperative pain and rehabilitation after total hip arthroplasty

Fusco, Pierfrancesco; Cofini, Vincenza; Petrucci, Emiliano; Scimia, Paolo; M, Fiorenzi; Paladini, Giuseppe; Behr, Astrid Ursula; Borghi, Battista; Flamini, Stefano; Pizzoferrato, Renzo; Colafarina, Olivo; Francesco, Alexander Di; Tabacco, Tito; Necozione, Stefano; Marinangeli, Franco

doi:10.23736/s0375-9393.17.12110-3

Cited by 18 publications

(9 citation statements)

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“…This multimodal approach resulted in better analgesia, decreased number of analgesia requests and improved physical therapy with less pain [234]. Although no infection was detected in this study, the authors emphasized strict use of aseptic techniques during catheter placement and care because of proximity to artificial implant material [234]. However, the analgesic benefit of WI has been questioned by a small recent RCT that showed no analgesic benefit with injecting ropivacaine vs. normal saline [235].…”

Section: Orthopedic Surgerymentioning

confidence: 78%

“…The follow up period was 72 h and additional analgesics included ketorolac and morphine [234]. This multimodal approach resulted in better analgesia, decreased number of analgesia requests and improved physical therapy with less pain [234]. Although no infection was detected in this study, the authors emphasized strict use of aseptic techniques during catheter placement and care because of proximity to artificial implant material [234].…”

Section: Orthopedic Surgerymentioning

confidence: 86%

Section: Orthopedic Surgerymentioning

confidence: 99%

“…In total hip replacement, combination of spinal anesthesia, CWI with levobupivacaine and local infiltration analgesia next to the implant, fascial and subcutaneous tissues was compared with placebo [234]. The follow up period was 72 h and additional analgesics included ketorolac and morphine [234]. This multimodal approach resulted in better analgesia, decreased number of analgesia requests and improved physical therapy with less pain [234].…”

Section: Orthopedic Surgerymentioning

confidence: 99%

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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

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Section: Orthopedic Surgerymentioning

confidence: 78%

Section: Orthopedic Surgerymentioning

confidence: 86%

Section: Orthopedic Surgerymentioning

confidence: 99%

Section: Orthopedic Surgerymentioning

confidence: 99%

See 2 more Smart Citations

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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show abstract

“…Two studies assessing multiple doses or continuous infusion of LIA compared with placebo [94,95] found improved postoperative pain scores and morphine consumption at 48-72 h with a pericapsular infusion via a catheter. However, a systemic effect of local anaesthesia cannot be ruled out, and three studies with a similar design failed to show any benefit [96][97][98].…”

Section: Local Infiltration Analgesiamentioning

confidence: 99%

PROSPECT guideline for total hip arthroplasty: a systematic review and procedure‐specific postoperative pain management recommendations

et al. 2021

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The aim of this systematic review was to develop recommendations for the management of postoperative pain after primary elective total hip arthroplasty, updating the previous procedure-specific postoperative pain management (PROSPECT) guidelines published in 2005 and updated in July 2010. Randomised controlled trials and meta-analyses published between July 2010 and December 2019 assessing postoperative pain using analgesic, anaesthetic, surgical or other interventions were identified from MEDLINE, Embase and Cochrane databases. Five hundred and twenty studies were initially identified, of which 108 randomised trials and 21 meta-analyses met the inclusion criteria. Peri-operative interventions that improved postoperative pain include: paracetamol; cyclo-oxygenase-2-selective inhibitors; non-steroidal anti-inflammatory drugs; and intravenous dexamethasone. In addition, peripheral nerve blocks (femoral nerve block; lumbar plexus block; fascia iliaca block), single-shot local infiltration analgesia, intrathecal morphine and epidural analgesia also improved pain. Limited or inconsistent evidence was found for all other approaches evaluated. Surgical and anaesthetic techniques appear to have a minor impact on postoperative pain, and thus their choice should be based on criteria other than pain. In summary, the analgesic regimen for total hip arthroplasty should include preoperative or intra-operative paracetamol and cyclo-oxygenase-2-selective inhibitors or non-steroidal antiinflammatory drugs, continued postoperatively with opioids used as rescue analgesics. In addition, intraoperative intravenous dexamethasone 8-10 mg is recommended. Regional analgesic techniques such as fascia iliaca block or local infiltration analgesia are recommended, especially if there are contra-indications to basic analgesics and/or in patients with high expected postoperative pain. Epidural analgesia, femoral nerve block, lumbar plexus block and gabapentinoid administration are not recommended as the adverse effects outweigh the benefits. Although intrathecal morphine 0.1 mg can be used, the PROSPECT group emphasises the risks and side-effects associated with its use and provides evidence that adequate analgesia may be achieved with basic analgesics and regional techniques without intrathecal morphine.

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May a Distance Learning Course in Statistics Satisfy Medical Students? The Experience with an Italian University Sample During the Covid Pandemic

Cofini

Medvedec

Vittorini

et al. 2022

Lecture Notes in Networks and Systems

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Continuous wound infusion and local infiltration analgesia for postoperative pain and rehabilitation after total hip arthroplasty

Cited by 18 publications

References 0 publications

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

PROSPECT guideline for total hip arthroplasty: a systematic review and procedure‐specific postoperative pain management recommendations

May a Distance Learning Course in Statistics Satisfy Medical Students? The Experience with an Italian University Sample During the Covid Pandemic

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