Ineffectiveness of Local Wound Anesthesia to Reduce Postoperative Pain After Median Sternotomy

Magnano, Diego; Montalbano, R N Roberto; Lamarra, Mauro; Ferri, Francesco; Lorini, Ferdinando Luca; Clarizia, S.; Rescigno, Giuseppe

doi:10.1111/j.1540-8191.2005.200318.x

Cited by 46 publications

(30 citation statements)

References 21 publications

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“…Analgesia was significantly improved but a weakness of this study was that the small number of patients underwent a variety of unmatched surgical procedures. In contrast, Mangano did not improve analgesia after sternotomy [27]. However, in this study, only 10 ml bupivacaine 0.5% was used to infiltrate the entire wound subcutaneously at the end of surgery , followed by a low volume infusion of 5 ml.h −1 , ensuring poor LA distribution throughout the wound.…”

Section: Surgical Applicationsmentioning

confidence: 86%

Wound infiltration for surgery

Scott

2010

Anaesthesia

117

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SummaryWound infiltration with local anaesthetics is a simple, effective and inexpensive means of providing good analgesia for a variety of surgical procedures without any major side-effects. In particular, local anaesthetic toxicity, wound infection and healing do not appear to be major considerations. The purpose of this review is to outline the existing literature on a procedure-specific basis and to encourage a more widespread acceptance of the technique, ensuring that all layers are infiltrated in a controlled and meticulous manner. A thorough understanding of the pathophysiology of the surgical wound is necessary to improve both analgesia and postoperative recovery for any given operation. Crile's concept of anoci-association almost a century ago has been largely ignored by our specialty. Crile proposed that true peripheral afferent blockade prevents propagation of abnormal reflexes that cause major organ dysfunction and death [1]. Thus, postoperative complications can be minimised and recovery enhanced. Since Crile's original hypothesis, we have learnt that the major reasons for surgical morbidity and mortality are the operation itself, the surgeon's personal expertise, the stress response to that trauma and patient comorbidities.Postoperative analgesia is a major component of perioperative care and local anaesthetic (LA) techniques are more effective than systemic analgesia regardless of the operation and mode of delivery [2]. Until recently, research and clinical practice has focused on central neuraxial blockade and peripheral nerve blockade. These, although highly effective, are reserved for major thoracic and abdominal surgery, mainly because of high failure rates [3] and the risks of infection and spinal haematoma. When choosing a 'procedure-specific' technique, the simplest, safest and most effective block should be employed whenever possible [4]. Thus, the meticulous direct application of LA to each identifiable layer during a surgical procedure has considerable appeal for both surgeon and anaesthetist. Local anaesthetic infiltration for surgery itself has largely been confined to small superficial outpatient procedures. However, performed well, this is a logical means of preventing pain and other noxious stimuli from reaching the spinal cord. When combined with specific nerve blockade, e.g. ilio-inguinal nerve block or transversus abdominis plane (TAP) block during hernia repair, this allows a 'multimodal local anaesthetic' means of combating pain and anoci-association.By allowing patients to mobilise more quickly, wound infiltration may be as effective as central and proximal peripheral blocks in ensuring a safe postoperative recovery. Although untreated postsurgical pain may cause chronic pain [5], our knowledge of its pathogenesis, prevention and treatment is still basic. An individual patient's personality and pain response are important and may correlate to early postoperative pain appreciation and outcome. During surgery, multimodal analgesia combats peripheral and central 'wind-up' and sho...

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Section: Surgical Applicationsmentioning

confidence: 86%

Wound infiltration for surgery

Scott

2010

Anaesthesia

117

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“…Muller et al [46] showed that 51% of heart surgery patients still had sternotomy pain on the 7 th postoperative day. In the postoperative period, routine procedures such as movement in bed and mediastinal drain manipulation can influence respiration mechanics and cough ability [47,48]. Another factor that contributes to impaired lung function and respiratory mechanics is the cardiopulmonary bypass (CPB) itself.…”

Section: Discussionmentioning

confidence: 99%

Respiratory pressures and expiratory peak flow rate of patients undergoing coronary artery bypass graft surgery

et al. 2012

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SummaryBackgroundTo evaluate clinical and laboratorial parameters that predict decreased respiratory function in patients subjected to coronary artery bypass graft surgery (CABG).Material/MethodsThis was a prospective study evaluating 61 patients subjected to CABG with cardiopulmonary bypass, median sternotomy, and under mechanical ventilation for up to 24 h. One day before surgery, clinical information was recorded. Maximal inspiratory (MIP) and expiratory (MEP) pressures, and expiratory peak flow rate (EPFR) values were assessed 1 day before surgery and on the fifth postoperative day. Student’s t test, 2-way ANOVA, Pearson’s linear correlation, and logistic regression were used for statistical analysis.ResultsPatients were 63±10 years old, 67% males. Arterial hypertension was found in 75.4% of the patients, diabetes in 31.2%, dyslipidemia in 63.9%, tabagism in 25%, and chronic obstructive pulmonary disease (COPD) in 16.4%. Previous myocardial infarction was found in 67%. Preoperative hemoglobin levels were 12.8±1.71 g/dL. Older individuals had lower preoperative MEP and EPFR values. Preoperatively, positive association was found between hemoglobin levels and maximal respiratory pressures and EPFR values. Patients with both class III angina and COPD presented higher reductions in pulmonary pressures between the preoperative period and the 5th postoperative day.ConclusionsOlder age and low hemoglobin levels are associated with preoperative low maximal respiratory pressures and EPFR. The combination of severe angina and COPD results in higher postoperative reduction of maximal respiratory pressures for patients who underwent CABG.

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“…[126][127][128][129][130][131][132][133] No evidence regarding their effect on the development of chronic pain exists. 126 …”

Section: Continuous Wound Cathetermentioning

confidence: 99%

Chronic Poststernotomy Pain

Kleiman

Sanders

Nemergut

et al. 2017

Regional Anesthesia and Pain Medicine

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Chronic pain following median sternotomy is common after cardiac surgery. If left untreated, chronic sternal pain can reduce quality of life, affecting sleep, mood, activity level, and overall satisfaction. This has a significant societal effect given the large number of cardiac surgeries annually. Although a number of pathophysiologic processes and risk factors are assumed to contribute, the exact cause and major risk factors remain unknown. Moreover, the treatment of chronic poststernotomy pain is often inadequate, relying on opioids and other medications that provide minimal benefit to the patient and have significant adverse effects. Indeed, little is known regarding the prevention of chronic pain development following sternotomy. This review aims to present the current, limited data regarding the incidence, risk factors, treatment, and prevention of chronic poststernotomy pain and to identify areas of future research to improve management of this common complaint following cardiac surgery.

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Ineffectiveness of Local Wound Anesthesia to Reduce Postoperative Pain After Median Sternotomy

Cited by 46 publications

References 21 publications

Wound infiltration for surgery

Wound infiltration for surgery

Respiratory pressures and expiratory peak flow rate of patients undergoing coronary artery bypass graft surgery

Chronic Poststernotomy Pain

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