Wound infiltration for surgery

Abstract

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...

Acid-Sensing Ion Channels in Postoperative Pain

“…Interestingly, a single intraoperative application of an ASIC3 inhibitor evokes a potent analgesic effect 24 h after surgery. ASIC3 may thus represent a new pharmacological target for the management of postoperative pain in addition to wound infiltration with local anesthetics (Liu et al, 2006;Scott, 2010) and other currently available approaches.…”

Postoperative Analgesia in Thoracic Surgery: A Comparison between Continuous Paravertebral Nerve Block and Continuous Incisional Infusion with OnQ Pain Relief System

“…The injection of a local anaesthetic at the surgical site reduces pain inhibiting transmission of the nociceptive impulses from the site of injury. Moreover, Hopf emphasized that the reduction in pain caused by local infiltration reduces the decreased wound perfusion and oxygenation induced by inflammatory response and increased catecholamines, thus improving wound healing [13,14] …”

Anaesthetic considerations for pectus repair surgery

“…A number of nerve blocks have been described to provide analgesia after sternotomy. One approach it to perform bilateral parasternal block (87), which is essentially infiltration of local anaesthetic under direct vision. A novel technique of 'pectoralis block' (commonly known as 'PECS Block'), which involves infiltration of local anaesthetic in the fascial plane between pectoralis major and minor has been described by Blanco (88).…”