Does local infiltration anesthesia on laparoscopic surgical wounds reduce postoperative pain? Randomized control study

Sugihara, Mika; Miyake, Takahito; Miyagi, Yasunari; Oda, Takashi; Hazama, Yukiko; Sano, Rikiya; Nakamura, Takafumi; Shiota, Mitsuru; Shimoya, Koichiro

doi:10.1002/rmb2.12224

Cited by 16 publications

(12 citation statements)

References 15 publications

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“…We identified 18 studies investigating WI in different gynecological procedures. Most studies were placebo controlled [221][222][223] and one compared liposomal bupivacaine with 0.25% bupivacaine [224]. PROSPECT recommends WI for elective Cesarean section and abdominal hysterectomy [8].…”

Section: Gynecological Surgerymentioning

confidence: 99%

“…CWI with ropivacaine provided similar analgesic effects as PCA fentanyl and ketorolac after laparoscopic gynecologic surgery, and despite higher rescue analgesic use, benefits included opioid-sparing effects and fewer side effects during 24 h follow up [225]. Single WI with levobupivacaine [221,222], bupivacaine [223], or liposomal bupivacaine [224] in addition to general anesthesia and standard analgesic therapy including NSAIDs or paracetamol and opioids significantly decreased postoperative analgesic requirement [221][222][223][224], lowered pain intensity [221,222,224] and reduced time to ambulation after laparoscopic [221,222,224] and open gynecological surgery [223]. The effects lasted for several to twelve hours [221].…”

Section: Gynecological 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: Gynecological Surgerymentioning

confidence: 99%

Section: Gynecological Surgerymentioning

confidence: 99%

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

Stamenković

Bezmarević

Bojić

et al. 2021

JCM

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“…The pain associated with laparoscopic gynecological surgery includes visceral pain from manipulation of the uterus, fallopian tube, and vagina, and parietal pain from stretching of the parietal peritoneum by pneumoperitoneum and port insertion in the abdominal wall. Commonly, LAI at the port site or intraperitoneally has been used together with opioids, NSAIDs, dexamethasone, and lidocaine infusion for multimodal analgesia for laparoscopic gynecological surgeries [ 15 , 16 ]. Despite several studies on LAI at port sites or intraperitoneally, the results of its analgesic effect are controversial.…”

Section: Discussionmentioning

confidence: 99%

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial

Sethi

Garg

2022

Anesth Pain Med

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Background: This study aimed to determine whether ultrasound-guided transversus abdominis plane (TAP) block is more effective in reducing postoperative pain and analgesic consumption than local anesthetic infiltration (LAI) at the port site for elective laparoscopic gynecological surgeries.Methods: Eighty patients with the American Society of Anesthesiologists status I/II undergoing laparoscopic gynecology surgery were enrolled for this randomized control trial. After general anesthesia was administered, patients in group C received LAI at each port site, and patients in group T received bilateral ultrasound-guided TAP. Postoperative pain was assessed at time intervals of 1/2, 2, 4, 6, 8, and 24 h using the numeric pain scale (NPS). Clinical metrics such as postoperative analgesic diclofenac consumption, need for rescue fentanyl, nausea-vomiting scores, and antiemetic requirements were also recorded.Results: Seventy-four patients were included in the final analysis. Postoperatively, patients in group T had significantly lower NPS than those in group C (P < 0.05). The highest difference in the postoperative NPS was observed at 2 h (median [1Q, 3Q]; group C = 3 [2, 4]; group T = 1 [0, 2]; P < 0.001). A statistically significant difference was observed in the frequency of diclofenac (75 mg intravenous) requirement between the groups (P = 0.010). No significant difference was observed between the groups in need of rescue fentanyl or antiemetic and the nausea-vomiting scores.Conclusions: In patients undergoing laparoscopic gynecological surgery, ultrasound-guided TAP block provided greater postoperative analgesic benefits in terms of lower NPS and reduced analgesic requirements than port site LAI.

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“…The primary outcome of this study was pain evaluated by the patient based on verbal numerical rating scale (0-10) at Post Anesthetic Care Unit after laparoscopic surgery. The scores were categorized into no pain (0), mild pain (1-3), moderate pain (4-6), and severe pain (7)(8)(9)(10). Then patients were divided into two groups, no/mild pain and moderate to severe pain.…”

Section: Methodsmentioning

confidence: 99%

“…However few studies documented surgical factors including duration of surgery, port site and intra-abdominal pressure 8,9 , which would be correlated with pain after laparoscopic procedures. Moreover, anesthetic factors such as local infiltration anesthesia 10 , paracetamol 11 , and parecoxib 12 would be the prophylactic factors to reduce pain.…”

Section: Introductionmentioning

confidence: 99%

Factors Associated with Moderate to Severe Pain after Laparoscopic Surgery

Kunapaisal

Pattaravit

Thongsuksai

2021

J Health Sci Med Res

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Objective: The aim of this study was to describe associated factors of patients with moderate to severe pain after laparoscopic abdominal surgery in Post Anesthetic Care Unit.Material and Methods: This retrospective study included patients who underwent laparoscopic abdominal surgeries (bariatric, colorectal, gynecological, urological, and upper gastrointestinal surgery) between February and July 2019. Demographic data were retrieved from the anesthetic records. Pain score was evaluated by self- rating using verbal numerical rating scale (0-10). Logistic regression was used to obtain independent risk factors of moderate to severe (score 4-10) pain against no or mild pain.Results: Two-hundred and ten patients were included. The incidence of moderate (score 4-6) to severe pain (score 7-10) was 50.0%. Those who suffered from moderate to severe pain required higher consumption of analgesic drugs in recovery room than the other groups, however durations of hospitalization were not different between the two groups (p-value=0.329). This was because the highest intensity of pain was in the first postoperative day. A multivariate logistic regression analysis revealed that abdominal pressure more than 12 mmHg (odd ratio (OR)=1.84, 95% confidence interval (CI) 0.8-4.22, p-value=0.153), and operation time more than 3 hours (OR 1.49, 95% CI 0.86-2.61, p-value=0.158) were independent risk factors of moderate to severe pain after laparoscopic procedureConclusion: High intra-abdominal pressure (≥12 mmHg) and prolonged operation time (>3 hours) are the independent risk factors of moderate and severe pain in laparoscopic surgery.

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Does local infiltration anesthesia on laparoscopic surgical wounds reduce postoperative pain? Randomized control study

Cited by 16 publications

References 15 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

Analgesic efficacy of ultrasound-guided transversus abdominis plane block for laparoscopic gynecological surgery: a randomized controlled trial

Factors Associated with Moderate to Severe Pain after Laparoscopic Surgery

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