Surgically placed wound catheters (SPWC) and local anaesthetic infusion in breast surgery: Efficacy and safety analysis

Raghavendra, Gargeshwari Krishnamurthy Guru; Sreenivasa, Roopa Harlur; Ashok, Kiran; Chitsabesan, Praminthra; McLean, N.R.; Youssef, Magdy M.; Piper, Merisa; Carr, Michael

doi:10.3233/bd-2010-0316

Cited by 15 publications

(6 citation statements)

References 21 publications

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“…Remaining unexplained is why-if both treatment groups received levobupivacaine 0.25% (30 mL) infiltrated at the end of surgery-did the group with the placebo infusion demonstrate such a dramatic difference in pain and analgesic requirements within the recovery room? This irregularity calls into question the remainder of the study results, especially since a meta-analysis of four similar RCTs failed to detect a statistically significant difference between a local anesthetic and placebo infusion in any variable at any time point following breast surgery [60].…”

Section: Wound Infusionmentioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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Objective. To review the published evidence regarding perioperative analgesic techniques for breast cancer-related surgery.Design. Topical review.Methods. Randomized, controlled trials (RCTs) were selected for inclusion in the review. Also included were large prospective series providing estimates of potential risks and technical reports and small case series demonstrating a new technique or approaches of interest to clinicians.Results. A total of 514 abstracts were reviewed, with 284 studies meeting criteria for full review. The evidence regarding preemptive ketamine, scheduled opioids, perioperative non-steroidal anti-inflammatory drugs (NSAIDs), and intravenous lidocaine is mixed and deserves further investigation. There is strong evidence that both pregabalin and gabapentin provide analgesic benefits following breast surgery. There is minimal and conflicting data from highquality randomized, controlled studies suggesting that directly infiltrating and/or infusing local anesthetic (liposome encapsulated or unencapsulated) into the surgical wound is a reliably effective analgesic. In contrast, there is a plethora of data demonstrating the potent analgesia, opioid sparing, and decreased opioid-related side effects from thoracic epidural infusion and both single-injection and continuous paravertebral nerve blocks (the latter two demonstrating decreased persistent post-surgical pain between 2.5 and 12 months). Techniques with limited-yet promising-data deserving additional investigation include brachial plexus blocks, cervical epidural infusion, interfascial plane blocks, and interpleural blocks.Conclusions. While there are currently multiple promising analgesic techniques for surgical procedures of the breast that deserve further study, the only modalities demonstrated to provide potent, consistent perioperative pain control are thoracic epidural infusion and paravertebral nerve blocks.

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Section: Wound Infusionmentioning

confidence: 99%

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

Cheng

2016

Pain Med

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“…[82][83][84] In the same way, continuous LA infusion through surgically placed wound catheters can conveniently prolong the pain control with reduced side effects including sedation, nausea and vomiting. 85,86 Furthermore, the placement of continuous infusion catheters did not require additional surgical skills and the infusion pump or infusion catheter did not hinder patients during the postoperative stay. 85 Compared to other local anesthesia techniques, Bouman et al did not find any difference in pain scores between continuous paravertebral block and continuous LA infusion after oncological breast surgery, pointing out that the latter may be preferable due to the lower incidence of associated complications.…”

Section: Breast Surgerymentioning

confidence: 99%

“…85,86 Furthermore, the placement of continuous infusion catheters did not require additional surgical skills and the infusion pump or infusion catheter did not hinder patients during the postoperative stay. 85 Compared to other local anesthesia techniques, Bouman et al did not find any difference in pain scores between continuous paravertebral block and continuous LA infusion after oncological breast surgery, pointing out that the latter may be preferable due to the lower incidence of associated complications. 87 Even delivering LAs through the surgical drain may have some advantages.…”

Section: Breast 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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“…[4][5][6][7] A meta-analysis of surgically placed wound catheters (SPWCs) for the management of postoperative pain after breast surgery looked at 4 randomised controlled trials (RCTs) including a total of 147 women. 8 This study showed a trend towards improved pain control. Although it was poorly powered, it was encouraging in terms of the safety and efficacy of SPWCs.…”

Section: Discussionmentioning

confidence: 99%

Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

Chaudhry

Hallam

Chambers

et al. 2015

annals

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INTRODUCTION Postoperative pain after breast surgery is one of the major factors contributing to delay in mobilisation and prolonged hospital stay. A retrospective analysis was performed of patients undergoing skin sparing mastectomy and insertion of a subpectoral implant. The aim was to determine whether the use of an elastomeric local anaesthetic pump improved pain control and length of stay. METHODS Twenty-five consecutive patients undergoing the above procedure were sited with an elastomeric local anaesthetic infusion pump intraoperatively, in addition to standard regular and pro re nata analgesia. The control group comprised 25 patients undergoing the same procedure in the same year who received standard analgesia alone. Visual analogue scale scores were recorded for the duration of inpatient stay, as was any further analgesic requirement. RESULTS The median age was 51 years (range: 26-75 years) in the intervention group and 50 years (range: 28-70 years) in the control group. The mean visual analogue scale score was 0.28 (standard deviation [SD]: 0.61) at 24 hours for the intervention group and 1.84 (SD: 0.37) for the control group (p<0.0001). The mean length of stay was 1.8 days (SD: 0.71 days) for the intervention group and 2.28 days (SD: 0.94 days) for the control group (p=0.15). There were no complications involving catheter placement, leakage or toxicity relating to use of the local anaesthetic. CONCLUSIONS There was significantly reduced pain with the use of the local anaesthetic infusion pump. The elastomeric pump is a step towards enhanced patient recovery after breast surgery in the case of skin sparing mastectomy and subpectoral tissue expander reconstruction.

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Surgically placed wound catheters (SPWC) and local anaesthetic infusion in breast surgery: Efficacy and safety analysis

Cited by 15 publications

References 21 publications

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

An Evidence-Based Review of the Efficacy of Perioperative Analgesic Techniques for Breast Cancer-Related Surgery

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

Improving postoperative pain management in subpectoral tissue expander implant reconstruction of the breast using an elastomeric pump

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