Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Abstract

Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

Postoperative Pain Control by Local Infiltration Analgesia and Peripheral Nerve Block in Primary Prosthetic Total Knee Arthroplasty

“… 39 , 40 Since the systemic toxicity of LIA can affect up to 11% of patients, the post-op monitoring of LIA patients cannot be ignored. 41 A similar observation was made by Tian et al; their retrospective TKA study showed that the short-term analgesic effect of LIA was similar to that of nerve block and reduced the need for opiate supplementation, and that LIA and nerve block had similar complication rates. 42 There is also evidence of marginal early post-op pain management improvement in patients treated by LIA as compared to peripheral nerve block, when evaluated 24 hours post-op.…”

Status quo of pain‐related patient‐reported outcomes and perioperative pain management in 10,415 patients from 10 countries: Analysis of registry data

“…Patients should receive some form of local or regional anaesthesia, as this is effective for controlling movement-evoked pain (Shanthanna et al, 2021). Wound infiltration is simple to carry out and inexpensive (Stamenkovic et al, 2021). The infrequent use of wound infiltration was not explained by frequent use of regional anaesthesia.…”

Multimodale Schmerzbehandlung nach Thorakotomie oder VATS: Eine mögliche Option für die Fast-Track-Chirurgie

“…Sowohl bei der Thorakotomie als auch bei der thorakoskopischen Chirurgie (video-assisted thorascopic surgery, VATS) hat sich gezeigt, dass die lokale Wundinfiltration (LWI) zu niedrigeren Schmerzscores und einem geringeren Analgetikaverbrauch führte. Außerdem konnten die Autoren anderer aktueller Studien zeigen, dass mit der LWI im Vergleich zum Placebo die Patientenzufriedenheit erhöht, die Mobilisation früher erfolgen, und somit der postoperative Krankenhausaufenthalt verkürzt werden konnte [1, 2].…”