Local anaesthetic wound infusion for acute postoperative pain: a viable option?

Thornton, Patrick; Buggy, Donal J.

doi:10.1093/bja/aer293

Cited by 40 publications

(27 citation statements)

References 23 publications

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“…In perspectives of ERAS, local anesthetics continuous infusion may be an attractive alternative to systemic opioids or neuraxial block, especially if neuraxial block is not indicated [9102023], because the former may enable adequate analgesia with early return of bowel function and a shorter hospital stay. However, different studies yield disparate results on ropivacaine wound infusion, with some studies reporting beneficial effects and others reporting no beneficial effects [212425].…”

Section: Discussionmentioning

confidence: 99%

Randomized trial of subfascial infusion of ropivacaine for early recovery in laparoscopic colorectal cancer surgery

Lee

Sim

Kim

et al. 2016

Korean J Anesthesiol

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BackgroundThere is a need for investigating the analgesic method as part of early recovery after surgery tailored for laparoscopic colorectal cancer (LCRC) surgery. In this randomized trial, we aimed to investigate the analgesic efficacy of an inverse ‘v’ shaped bilateral, subfascial ropivacaine continuous infusion in LCRC surgery.MethodsForty two patients undergoing elective LCRC surgery were randomly allocated to one of two groups to receive either 0.5% ropivacaine continuous infusion at the subfascial plane (n = 20, R group) or fentanyl intravenous patient controlled analgesia (IV PCA) (n = 22, F group) for postoperative 72 hours. The primary endpoint was the visual analogue scores (VAS) when coughing at postoperative 24 hours. Secondary end points were the VAS at 1, 6, 48, and 72 hours, time to first flatus, time to first rescue meperidine requirement, rescue meperidine consumption, length of hospital stay, postoperative nausea and vomiting, sedation, hypotension, dizziness, headache, and wound complications.ResultsThe VAS at rest and when coughing were similar between the groups throughout the study. The time to first gas passage and time to first rescue meperidine at ward were significantly shorter in the R group compared to the F group (P = 0.010). Rescue meperidine was administered less in the R group; however, without statistical significance. Other study parameters were not different between the groups.ConclusionsRopivacaine continuous infusion with an inverse ‘v ’ shaped bilateral, subfascial catheter placement showed significantly enhanced bowel recovery and analgesic efficacy was not different from IV PCA in LCRC surgery.

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Section: Discussionmentioning

confidence: 99%

Randomized trial of subfascial infusion of ropivacaine for early recovery in laparoscopic colorectal cancer surgery

Lee

Sim

Kim

et al. 2016

Korean J Anesthesiol

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“…40,41 Since bupivacaine and ropivacaine are slower and longer acting than lidocaine and procaine, which are fast and short-lived, these anesthetics would generally be chosen, especially if only one application is administered. 23,26,38,39 However, although they are relatively toxic at higher concentrations, lower dose administration may be used with continuous administration to reduce toxicity.…”

Section: Discussionmentioning

confidence: 99%

Effect of Local Anesthetics on Human Mesenchymal Stromal Cell Secretion

et al. 2015

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Anti-fibrotic and tissue regenerative mesenchymal stromal cell (MSC) properties are largely mediated by secreted cytokines and growth factors. MSCs are implanted to augment joint cartilage replacement and to treat diabetic ulcers and burn injuries simultaneously with local anesthetics, which reduce pain. However, the effect of anesthetics on therapeutic human MSC secretory function has not been evaluated. In order to assess the effect of local anesthetics on the MSC secretome, a panel of four anesthetics with different potencies — lidocaine, procaine, ropivacaine and bupivacaine — was evaluated. Since injured tissues secrete inflammatory cytokines, the effects of anesthetics on MSCs stimulated with tumor necrosis factor (TNF)-α and interferon (IFN)-γ were also measured. Dose dependent and anesthesia specific effects on cell viability, post exposure proliferation and secretory function were quantified using alamar blue reduction and immunoassays, respectively. Computational pathway analysis was performed to identify upstream regulators and molecular pathways likely associated with the effects of these chemicals on the MSC secretome. Our results indicated while neither lidocaine nor procaine greatly reduced unstimulated cell viability, ropivacaine and bupivacaine induced dose dependent viability decreases. This pattern was exaggerated in the simulated inflammatory environment. The reversibility of these effects after withdrawal of the anesthetics was attenuated for TNF-α/IFN-γ-stimulated MSCs exposed to ropivacaine and bupivacaine. In addition, secretome analysis indicated that constitutive secretion changes were clearly affected by both anesthetic alone and anesthetic plus TNFα/IFNγ cell stimulation, but the secretory pattern was drug specific and did not necessarily coincide with viability changes. Pathway analysis identified different intracellular regulators for stimulated and unstimulated MSCs. Within these groups, ropivacaine and bupivacaine appeared to act on MSCs similarly via the same regulatory mechanisms. Given the variable effect of local anesthetics on MSC viability and function, these studies underscore the need to evaluate MSC in the presence of medications, such as anesthetics, that are likely to accompany cell implantation.

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“…However, despite the widespread use of LIA, there is relatively limited evidence for the optimal drug combination. 1,2 Moreover, most trials have not included a systemic control group for the combination of locally infiltrated drugs. 2 Previous animal studies have shown that laparotomy causes decreased spontaneous locomotor activity in rats, especially rearing behavior.…”

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confidence: 99%