Effectiveness of continuous wound infusion of local anesthetics after abdominal surgeries

Dhanapal, Baskaran; Sistla, Sarath Chandra; Badhe, Ashok Shankar; Ali, Sheikh Manwar; Ravichandran, Niranjan T.; Galidevara, Indira

doi:10.1016/j.jss.2016.12.027

Cited by 23 publications

(24 citation statements)

References 28 publications

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“…As regards the first macro-area (laparotomy), all the analyzed studies agree in demonstrating the superiority of CWI compared to single-shot nerve blocks or placebo in ensuring better pain relief, lower opioid consumption, lower opioid-related side effects; enhancing, at the same time, the postoperative recovery. [21][22][23][24][25][26][27] Unfortunately, the same conclusions cannot be drawn when CWI is compared to epidural analgesia (EA). In this field there is a high heterogeneity and, while some RCTs have shown a better or similar analgesic effect of CWI when compared to EA, [28][29][30][31][32][33][34][35] others have claimed exactly the opposite; [36][37][38] often in the face of a higher incidence of side effects (ie, treatment failure, vasopressor requirement, prolonged recovery time) and higher costs.…”

Section: Lower Limb Surgerymentioning

confidence: 99%

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patientcontrolled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/ laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.

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Section: Lower Limb Surgerymentioning

confidence: 99%

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Paladini

Carlo

Musella

et al. 2020

JPR

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“…Laparotomy / Other Abdominal Surgery: [27,28,29,30,31,32,33,34,35,36,37] Eleven RCTs were identi ed related to…”

Section: Methodsmentioning

confidence: 99%

“…One trial employed rectus sheath block comparing 0.25% bupivacaine with saline [27]. Another trial studied continuous wound infusion comparing bupivacaine with saline [28]. Thoracic epidural was used in ve RCTs [29,30,31,32,33].…”

Section: Methodsmentioning

confidence: 99%

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Afshan

Khan²,

Ahmed³

et al. 2020

Preprint

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Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results:Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review

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“…[27]. Another trial studied continuous wound infusion comparing bupivacaine with saline [28]. Thoracic epidural was used in ve RCTs [29,30,31,32,33].…”

Section: Thoracotomymentioning

confidence: 99%

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

Afshan

Khan²,

Ahmed³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade. Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria. Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia. Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries.

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Effectiveness of continuous wound infusion of local anesthetics after abdominal surgeries

Cited by 23 publications

References 28 publications

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

<p>Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives</p>

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC: a systematic review

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