Novel techniques of local anaesthetic infiltration

Whiteman, Abigail; Bajaj, Sanjay; Hasan, Maan

doi:10.1093/bjaceaccp/mkr026

Cited by 30 publications

(24 citation statements)

References 13 publications

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“…The problem of short duration of analgesia associated with incisional infiltration can be overcome by giving a continuous infusion of a LA. At the end of the surgical procedure, the surgeon directly places a catheter into the wound 21. This is then attached to a pump that allows a preset amount of LA to be infused into the wound per hour.…”

Section: Discussionmentioning

confidence: 99%

Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons

Kaushal-Deep

Lodhi

Anees

et al. 2019

Postgraduate Medical Journal

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BackgroundPain is the main reason for staying overnight at hospital after an uncomplicated laparoscopic cholecystectomy.ObjectivesA randomised prospective study was planned to compare the efficacy of intraincisional and intraperitoneal use of 0.2% ropivacaine so that patients undergoing an uncomplicated laparoscopic cholecystectomy can be discharged as a day case in a cost-effective way.Methods191 patients were operated by elective four-port laparoscopic cholecystectomy. They were randomised into three groups after triple blinding according to location of 0.2% ropivacaine use. All patients were given ~23 mL of solution (drug or normal saline depending on the group), 20 mL of which was given at intraperitoneal location and ~1 mL/cm of incision intraincisionally. Pain scores (Visual Analogue Scale (VAS), Numeric Rating Scale (NRS) and Faces Pain Scale-Revised (FPS-R)) were evaluated at 4 and 8 hours postoperatively. Only those patients with a VAS ≤3, NRS ≤3 and FPS-R ≤2, no requirement of rescue analgesia, no shoulder pain, ambulated at least once, passed urine and taking oral sips were offered discharge as a day case.Results31% of patients in intraperitoneal group (n=62) could be discharged as a day case as compared with 48% in intraincisional group (n=68) (p>0.05) and 89% in combined group (n=61) (p<0.05, with respect to both other groups).ConclusionThe combined use of intraincisional and intraperitoneal ropivacaine is a cost-effective way of discharging approximately 9 in 10 patients as a day case. This study is unique as this is the first study in which only a local anaesthetic has been used to predict discharges as a day case.

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Section: Discussionmentioning

confidence: 99%

Randomised prospective study of using intraoperative, intraincisional and intraperitoneal ropivacaine for the early discharge of post-laparoscopic cholecystectomy patients as a day case in a cost-effective way in government setup of low-income and middle-income countries: Opening new horizons

Kaushal-Deep

Lodhi

Anees

et al. 2019

Postgraduate Medical Journal

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“…Multimodalna postoperativna analgezija ubrzava neposredni postoperativni oporavak bolesnika, snižava dozu primenjenih opioidnih analgetika i skraćuje trajanje hospitalizacije 14,15,16 . Dodatno, adekvatna postoperativna analgezija snižava bolničke troškove, kao i mogućnost bržeg vraćanja pacijenata regularnom životu i radnim obavezama 19 . U tom smislu, razvijeno je nekoliko tehnika postoperativne analgezije uz upotrebu lokalnih aneste-tika, među kojima se izdvojila kontinuirana infiltracija postoperativne rane lokalnim anesteticima (continuous wound infiltration -CWI), koja u terapiji postoperativnog bola može da se koristi samostalno i kao segment multimodalnog pristupa 13,20 .…”

Section: Primena Infiltracije Rane Lokalnim Anesteticima U Cilju Postunclassified

“…U oblasti kolorektalane hirurgije kontinuirana infiltracija postoperativne rane je pokazala efikasnu analgeziju, snizila postoperativnu potrebu za opioidima i ubrzala postoperativni oporavak uz potpunu ekonomsku isplativost 19,21 . Ako se uzme u obzir i lako tehničko izvođenje, visok stepen uspešnosti i dobra podnošljivost, jasno je da je kontinuirana infiltracija operativne rane nepravedno zapostavljena tehnika 22 .…”

Section: Primena Infiltracije Rane Lokalnim Anesteticima U Cilju Postunclassified

“…Pitanja koja se nameću hirurgu suočenom sa predlogom da na kraju operativnog zahvata postavi sistem za kontinuiranu infiltraciju anesteticima su: da li ovakav sistem zaista ima analgetski efekat i da li postoji rizik za nastanak postoperativne infekcije? Efekat analgezije kontinuiranom infiltracijom lokalnih anestetika zavisi, ako izuzmemo iskustvo hirurga, od vrste hirurške intervencije, mesta postavljanja katetera za distribuciju anestezije, kao i od količine i koncentracije lokalnog anestetika 19,20,23 .…”

Section: Primena Infiltracije Rane Lokalnim Anesteticima U Cilju Postunclassified

“…Zagovornici preoperativne infiltracije obrazlažu njen efekat u smislu snižavanja intraoperativnih analgetika, pre svega opioidnih i neopioidnih analgetika 23 . Sa druge strane, preoperativna primena teorijski redukuje nociceptivni input i blokira fenomen vihora (wind-up phenomenon), izazvanog aktivacijom N-methyl-D-aspartate receptora, i oslobađanje medijatora inflamacije 19 . Nedostatak jednostruke infiltracije rane je trajanje analgezije u periodu trajanja efekta lokalnog anestetika, što u slučaju levobupivakaina i ropivakaina iznosi 4 do 8 časova, što je prevaziđeno plasiranjem specijalno konstruisanog katetera za kontinuiranu infiltrativnu anesteziju 19 .…”

Section: Jednostruka Infiltracija Operativne Rane Lokalnim Anestetikomunclassified

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Surgical wound infiltration by local anesthetic: Wound infiltration

Slavković¹,

Kostić²,

Milošević³

et al. 2019

Serb J Anest Inten Therapy

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SažetakSa razvojem ambulantne hirurgije, povećao se broj hirurških zahvata koji se izvode u uslovima lokalne infiltrativne anestezije. Infiltrativna anestezija se koristi samostalno za obezbeđivanje anestezije kod manjih hirurških procedura ili kao infiltrativna analgezija duž većih operativnih incizija u kombinaciji sa analgeticima, kod operacija u opštoj anesteziji, u sklopu multimodalnog analgetskog pristupa. Jednostruka infiltracija rane, u formi bloka na kraju hirurškog zahvata u opštoj ili regionalnoj anesteziji obezbeđuje kvalitetnu analgeziju u vremenski ograničenom intervalu, te je u cilju produženog delovanja lokalnih anestetika uvedena tehnika kontinuirane infiltrativne analgezije. Infiltrativna lokalna anestezija u kontinuiranom modalitetu smanjuje upotrebu opioidnih i neopioidnih analgetika, produžava trajanje analgezije (uglavom do 72 h) i omogućava mobilizaciju bolesnika. Pozitivan efekat infiltrativne anestezije opisan je kod operacija preponskih kila, dojke, u kardiotorakalnoj, ortopedskoj i ginekološkoj hirurgiji. U abdominalnoj hirurgiji kompleksna inervacija trbušnog zida i intraabdominalnih organa zahteva primenu kombinovanja infiltrativne anestezije sa drugim modalitetima analgezije. Infiltrativna lokalna anestezija je bezbedna tehnika jer ne dovodi do infekcije hirurške rane i ne utiče na pojavu infekcije mesta hirurškog reza. Kako bi lokalna infiltrativna anestezija u potpunosti ispunila i opravdala očekivanja, neophodno je savladati relativno jednostavnu tehniku njene primene i svrsishodno je primenjivati. AbstractA large number of surgical interventions are performed ambulatory under local infiltrative anesthesia. Local anesthetic wound infiltration provides anesthesia for minor surgical procedures and perioperatively improves analgesia after surgery in general anesthesia as part of a multimodal analgesic approach. The effect of a single block wound infiltration at the end of a surgical procedure in general or regional anesthesia provides additional analgesia for several hours. Infiltrative local anesthesia performed in a continuous modality reduces the use of analgesics, prolongs duration of analgesia and enhances the patient's mobilization. Benefits of local infiltrative anesthesia are described in inguinal hernioplasty, breast surgery, sternotomy, orthopedic, and gynecological surgery. However, in abdominal surgery, continuous infiltrative local anesthesia is combined with other analgesic modalities respecting complex innervation of the abdominal wall and intra-abdominal organs,. Wound infiltration is a safe technique without the risk of surgical wound infection. There is a lack of data about cost-benefit ratio when wound infiltration is used. In order for local infiltrative anesthesia to fully meet the expectations it is necessary to have mastery of the relatively simple technique, and the knowledge of when it is suitable to appply.

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