Efficacy of Continuous Wound Catheters Delivering Local Anesthetic for Postoperative Analgesia: A Quantitative and Qualitative Systematic Review of Randomized Controlled Trials

Liu, Spencer S.; Richman, Jeffrey M.; Thirlby, Richard C.; Wu, Christopher L.

doi:10.1016/j.jamcollsurg.2006.08.007

Cited by 492 publications

(352 citation statements)

References 62 publications

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“…Since the overall wound space after TKA is relatively small, it may be important to use a higher concentration of local anesthetic than those reported in the literature (about 0.2-0.25% ropivacaine or bupivacaine) and with a smaller volume. Such studies will undoubtedly have clinical implications for improvement of analgesia after TKA since the wound infusion techniques from all types of surgery have been reported to be safe and simple, with acceptable patient compliance (Liu et al 2006).…”

Section: Discussionmentioning

confidence: 99%

“…These techniques have been successful, although intraarticular administration per se may be less effective (Ritter et al 1999). Since continuous infusion of a wound with local anesthetic may have a significant role in future postoperative pain management in TKA (Liu et al 2006), there is a need for detailed systematic studies to evaluate the optimal site of administration of local anesthetic. The aim of this randomized, double-blind and placebo-controlled study was therefore to evaluate and compare the specific effects of injecting local anesthetic into the intraarticular or extraarticular tissues after TKA using the LIA technique (Rostlund and Kehlet 2007).…”

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confidence: 99%

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Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

et al. 2008

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Background High-volume local infiltration analgesia with additional intraarticular and wound administration of local anesthetic has been shown to be effective after knee replacement, but the optimum site of administration of the local anesthetic (i.e. intraarticular or extraarticular) has not been evaluated.Patients and methods 32 patients undergoing total knee replacement with high-volume (170 mL) 0.2% ropivacaine infiltration analgesia were randomized to receive injection of 20 mL ropivacaine (0.2%) intraarticularly plus 30 mL saline in the extraarticular wound space 24 hours postoperatively or to receive 20 mL ropivacaine (0.2%) intraarticularly plus 30 mL ropivacaine (0.2%) in the extraarticular wound space 24 hours postoperatively. Pain intensity at rest and with mobilization was recorded for 4 hours after administration of additional local anesthetics.Results Intensity of pain at rest, during flexion, or straight leg lift was not statistically significantly different between the two groups, but there was a tendency of improved analgesia with administration of additional local anesthetic in the extraarticular wound space.Interpretation The optimal site of administration of local anesthetic in total knee arthroplasty cannot be determined from the present study. However, the insignificant analgesic effect from additional administration of extraarticular local anaesthetic may have been due to the relatively low pain scores observed 24 h postoperatively, confirming the efficiency of the high-volume infiltration analgesia technique. Further studies are

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

et al. 2008

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“…A recent RCT in patients undergoing laparoscopic colorectal resection using the ERAS programme showed no difference in return of gastrointestinal function and LOSH between continuous infusion of lidocaine and thoracic epidural anaesthesia [100]. The efficacy of wound infusion with local anaesthetic agents as a postoperative analgesic method has been proven in a meta-analysis of different surgical procedures [101]. Conversely, a more recent meta-analysis showed that wound catheters provided no significant reduction in pain intensity (at rest or with activity) or in morphine consumption at any time after laparotomy [102].…”

Section: Midmentioning

confidence: 99%

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

et al. 2012

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“…In particular, if the catheter is placed subcutaneously there is no improvement of postoperative pain scores [15]. Forastiere and co-workers studied the effectiveness of continuous wound infusion of 0.5% ropivacaine by ON-Q system for postoperative pain after open nephrectomy showing that when this analgesic device is compared to placebo it decreases pain and narcotics [16].…”

Section: Citationmentioning

confidence: 99%

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

Cosmo

Federico²,

Sessa³

et al. 2013

J Anesthe Clinic Res

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Objectives: Thoracotomy is one of the most painful surgical stimuli and inadequate management of postthoracotomy pain is often associated with pulmonary and cardiac complications. The aim of this prospective, randomized, double-blinded study was to compare continuous paravertebral block versus continuous incisional infusion with OnQ Pain Relief System. Methods:Forty eight patients, undergoing thoracotomy for elective lobectomy, were randomized to receive a continuous paravertebral infusion of bupivacaine 0.25% through an elastomeric pump which delivers 0.1 mL/Kg/h (group A) or a continuous incisional infusion of bupivacaine 0.25% at an infusion rate of 4 mL/h with OnQ Pain Relief System (group B). Both infusions were started before wound closure, and continued for 48 postoperative hours. General anaesthesia was standardized. In the recovery room, patients were provided with intravenous morphine patient-controlled analgesia (PCA). Visual analogue scale at rest (VASr) and when coughing (VASi), rescue patientcontrolled analgesia morphine consumption, hemodynamic, time to ambulation and side-effects were evaluated within 48 h. Results:The two groups were comparable regarding to patients' number and characteristics, type of surgery, time to ambulation and side-effects; postoperative hemodynamic profile was stable in all the patients. Absolute pain scores were low in both groups; patients in group A reported significant lower VASr and VASi values during the postoperative 48 hours compared with group B (p<0.001). Total morphine consumption and PCA requests number were significantly lower in group A than in group B (p= 0.05 and p< 0.01).

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Efficacy of Continuous Wound Catheters Delivering Local Anesthetic for Postoperative Analgesia: A Quantitative and Qualitative Systematic Review of Randomized Controlled Trials

Cited by 492 publications

References 62 publications

Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

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Efficacy of Continuous Wound Catheters Delivering Local Anesthetic for Postoperative Analgesia: A Quantitative and Qualitative Systematic Review of Randomized Controlled Trials

Cited by 492 publications

References 62 publications

Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

Local anesthetics after total knee arthroplasty: intraarticular or extraarticular administration? A randomized, double-blind, placebo-controlled study

Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS®) Society Recommendations

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

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Guidelines for Perioperative Care for Pancreaticoduodenectomy: Enhanced Recovery After Surgery (ERAS^®) Society Recommendations