SUCCESSFUL SURGICAL MANAGEMENT OF PERINEAL HERNIA IN MURRAH BUFFALOES

Local anaesthetic wound infiltration techniques reduce opiate requirements and pain scores. Wound catheters have been introduced to increase the duration of action of local anaesthetic by continuous infusion. The aim was to compare these infiltration techniques with the current standard of epidural analgesia. A meta-analysis of randomized clinical trials (RCTs) evaluating wound infiltration versus epidural analgesia in abdominal surgery was performed. The primary outcome was pain score at rest after 24 h on a numerical rating scale. Secondary outcomes were pain scores at rest at 48 h, and on movement at 24 and 48 h, with subgroup analysis according to incision type and administration regimen(continuous versus bolus), opiate requirements, nausea and vomiting, urinary retention, catheter-related complications and treatment failure. Nine RCTs with a total of 505 patients were included. No differences in pain scores at rest 24 h after surgery were detected between epidural and wound infiltration. There were no significant differences in pain score at rest after 48 h, or on movement at 24 or 48 h after surgery. Epidural analgesia demonstrated a non-significant a trend towards reduced pain scores on movement and reduced opiate requirements. There was a reduced incidence of urinary retention in the wound catheter group. Within a heterogeneous group of RCTs, use of local anaesthetic wound infiltration was associated with pain scores comparable to those obtained with epidural analgesia. Further procedure-specific RCTs including broader measures of recovery are recommended to compare the overall efficacy of epidural and wound infiltration analgesic techniques.

Randomized clinical trial of local infiltration plus patient-controlled opiate analgesia vs. epidural analgesia following liver resection surgery

#36925 TAP block versus wound infiltration for abdominal surgery. Pro wound inflitration

Wound infiltration with local anaesthetics has been investigated as a potentially useful method for providing analgesia after caesarean delivery, but the literature is inconclusive. The objective is to assess the efficacy of local anaesthetic wound infiltration in reducing pain scores and opioid consumption in women undergoing caesarean delivery. Systematic review of randomised controlled trials with meta-analyses. MEDLINE, EMBASE, CINAHL, and Cochrane Central Register of Controlled trials (CENTRAL) until December 2015. Randomised controlled trials that assessed the efficacy of local anaesthetic wound infiltration using an infusion or single injection technique for postcaesarean section analgesia. A total of 21 studies were included in the final analysis (11 studies using an infusion technique and 10 studies using single infiltration). Local anaesthetic wound infiltration significantly decreased opioid consumption at 24 h [mean difference -9.69 mg morphine equivalents, 95% confidence interval (CI), -14.85 to -4.52] and pain scores after 24 h at rest (mean difference -0.36, 95% CI, -0.58 to -0.14) and on movement (mean difference -0.61, 95% CI, -1.19 to -0.03). Subgroup analysis did not suggest a difference in primary outcomes between infusions and single infiltration. Opioid consumption was reduced in patients who did not receive intrathecal morphine but not in those who received intrathecal morphine, although there were very little data in patients receiving intrathecal morphine. Pain scores at rest and on movement at 24 h were reduced with catheter placement below the fascia but not above the fascia. There were no statistically significant reductions in nausea, vomiting or pruritus with local anaesthetic infiltration. Local anaesthetic wound infiltration reduces postoperative opioid consumption but had minimal effect on pain scores and did not reduce opioid-related side-effects in women who had undergone delivery by caesarean section. The review is limited by a paucity of studies using intrathecal morphine and by the indirect comparisons performed for subgroup analyses.

Introduction: Percutaneous transforaminal endoscopic discectomy is a simple and effective treatment for lumbar intervertebral disc herniation, and local anesthesia is often applied in this kind of surgery in many developing countries, including China. However, many patients still feel excruciating pain under this condition. Epidural anesthesia with low-concentration ropivacaine has no impact on muscle strength, and patients might follow the surgeon well during operation. We hypothesize that epidural anesthesia is feasible for percutaneous transforaminal endoscopic discectomy.Methods: Two hundred patients with disc herniation who underwent percutaneous transforaminal endoscopic discectomy were randomized to receive either epidural anesthesia or local infiltration anesthesia. Primary outcome measures included the pain score, the cooperation degree, and patients' satisfaction. Mean arterial pressure and heart rate were also recorded.Results: Compared with the local anesthesia group, visual analog scale scores, mean arterial pressure, and heart rate were significantly lower in the epidural anesthesia group (P < 0.05), and patients' satisfaction was higher. There were no significant differences in the total operation time or blood loss between two groups.Conclusions: Epidural anesthesia with low-concentration ropivacaine and sufentanil is safe and effective for percutaneous transforaminal endoscopic discectomy.Clinical Trial Registration: ClinicalTrials.gov, identifier: ChiCTR-IOR-17011768.

BackgroundWe performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy and safety of local infiltration anesthesia (LIA) versus epidural analgesia (EPA) for postoperative pain control in total knee arthroplasty (TKA).MethodsIn December 2017, a systematic computer-based search was conducted in Pubmed, EMBASE, Web of Science, and Cochrane Database of Systematic Reviews. RCTs of patients prepared for spine surgery that compared LIA versus EPA for postoperative pain control in TKA were retrieved. The primary endpoint was the VAS score with rest or mobilization at 12, 24 and 48, and 72 h. The secondary outcomes were the range of motion, the length of stay, and the occurrence of infection and nausea. After testing for publication bias and heterogeneity between studies, data were aggregated for random-effects models when necessary.ResultsSeven clinical studies with 251 patients (LIA = 124, EPA = 127) were included in the meta-analysis. There was no significant difference between LIA and EPA group in terms of the VAS score with rest at 12 and 24 h. LIA was associated with a reduction of the VAS score with rest at 48 and 72 h than EPA (P < 0.05). There was no significant difference between the LIA group and EPA group in terms of the VAS with mobilization at 24, 48, and 72 h (P > 0.05). And LIA was associated with an increase of the range of motion at 24 and 48 h (P < 0.05) and a reduction of the length of hospital stay (P < 0.05). What is more, LIA was associated with a reduction of the occurrence of the nausea.ConclusionsLIA has equivalent efficacy as EPA for pain control after TKA and shows an increase of the range of motion and a reduction of the occurrence of nausea and length of hospital stay. Due to the limited number of the included studies, more high-quality RCTs are still needed to identify the long-term effects of LIA for pain control after TKA.

Effective postoperative analgesia is essential for early rehabilitation after surgery. Continuous wound infiltration (CWI) of local anesthetics has been proposed as an alternative to epidural analgesia (EA) during colorectal surgery. This prospective, double-blind trial compared CWI and EA in patients undergoing elective open colorectal surgery. Fifty consecutive patients were randomized to receive EA or CWI for 48 h. In both groups, patients were managed according to Enhanced Recovery After Surgery recommendations. The primary outcome was the dynamic pain score measured during mobilization 24 h after surgery (H24) using a 100-mm verbal numerical scale. Secondary outcomes were time to functional recovery, analgesic technique-related side effects, and length of hospital stay. Median postoperative dynamic pain score was lower in the EA than in the CWI group (10 [interquartile range: 1.6-20] vs. 37 [interquartile range: 30-49], P < 0.001) and remained lower until hospital discharge. The median times to return of gut function and tolerance of a normal, complete diet were shorter in the EA than in the CWI group (P < 0.01 each). Sleep quality was also better in the EA group, but there was no difference in urinary retention rate (P = 0.57). The median length of stay was lower in the EA than in the CWI group (4 [interquartile range: 3.4-5.3] days vs. 5.5 [interquartile range: 4.5-7] days; P = 0.006). Within an Enhanced Recovery After Surgery program, EA provided quicker functional recovery than CWI and reduced length of hospital stay after open colorectal surgery.

Postoperative pain control after total knee arthroplasty (TKA) is a well-known clinical problem. Efforts to treat it with the use of local anesthesia have been made, but the results have been contradictive. In the late 1990s, an infiltrated solution of ropivacaine/ketorolac/adrenaline was shown to be effective for this purpose, and this technique has since spread over the world. The purpose of this study was to compare the local infiltration anesthesia technique with epidural anesthesia, which has been the most widely used technique in Sweden.Eighty-five patients received either local infiltration anesthesia or epidural anesthesia for postoperative pain relief. Postoperative morphine consumption, range of motion, walking ability, patient satisfaction, hospital stay, and time in the recovery room were measured. The groups were followed equally. The patients in the local infiltration anesthesia group were mobilized 24 hours earlier. On postoperative day one, 22 of 33 patients in the local infiltration anesthesia group could get in and out of bed without assistance. Only 1 of 31 patients in the epidural anesthesia group could manage this. On postoperative day two, 28 of 33 patients in the local infiltration anesthesia group could walk without assistance, compared to 5 of 31 in the epidural anesthesia group. Seventy-six percent of the local infiltration anesthesia patients were "very satisfied" with their postoperative pain control method, compared to 40% of the epidural anesthesia patients.The local infiltration anesthesia technique is better for postoperative pain relief in TKA than epidural anesthesia. It offers equal pain relief, faster mobilization, and more satisfied patients. No negative side effects were seen during the study.

JUSTIFICATIVA E OBJETIVOS: A anestesia peridural toracica e utilizada com frequencia para procedimentos esteticos da mama e ha poucos relatos de seu emprego para mastectomias com exploracao axilar. O presente estudo comparou a tecnica com anestesia geral em operacoes oncologicas da mama. METODO: Quarenta pacientes foram divididas em dois grupos. No grupo peridural (n = 20) foi realizada peridural toracica com bupivacaina e fentanil associada a sedacao com midazolam. O outro grupo (n = 20) recebeu anestesia geral convencional com propofol, atracurio e fentanil e manutencao com O2 e isoflurano. Registraram-se no intra-operatorio duracao da operacao, necessidade de complementacao da anestesia ou da sedacao e variaveis hemodinâmicas. No pos-operatorio, foram registrados o tempo para alta da sala de recuperacao pos-anestesica e hospitalar, a intensidade da dor e o consumo de analgesicos, os efeitos adversos e a satisfacao com a tecnica anestesica. RESULTADOS: Os grupos foram semelhantes e nao houve diferenca na duracao da operacao. Foi necessario complementar a sedacao em 100% das pacientes que receberam anestesia peridural e em 15% foi complementada a analgesia com infiltracao de anestesico local na axila. Houve maior incidencia de hipertensao arterial no grupo da anestesia geral e de hipotensao entre as que receberam peridural. Ocorreu prurido em 55% das pacientes com anestesia peridural. Nausea (30%) e vomito (45%) foram mais frequentes entre as que receberam anestesia geral. A analgesia pos-operatoria teve melhor qualidade e o consumo de analgesicos foi menor no grupo da anestesia peridural. O periodo de internacao tambem foi menor. CONCLUSOES: A tecnica peridural tem algumas vantagens com relacao a anestesia geral e pode ser considerada uma opcao para anestesia em mastectomias oncologicas com esvaziamento axilar.

Whether preemptive analgesic interventions are more effective than conventional regimens in managing acute postoperative pain remains controversial. We systematically searched for randomized controlled trials that specifically compared preoperative analgesic interventions with similar postoperative analgesic interventions via the same route. The retrieved reports were stratified according to five types of analgesic interventions: epidural analgesia, local anesthetic wound infiltration, systemic N-methyl-d-aspartic acid (NMDA) receptor antagonists, systemic nonsteroidal antiinflammatory drugs (NSAIDs), and systemic opioids. The primary outcome measures analyzed were the pain intensity scores, supplemental analgesic consumption, and time to first analgesic consumption. Sixty-six studies with data from 3261 patients were analyzed. Data were combined by using a fixed-effect model, and the effect size index (ES) used was the standardized mean difference. When the data from all three outcome measures were combined, the ES was most pronounced for preemptive administration of epidural analgesia (ES, 0.38; 95% confidence interval [CI], 0.28-0.47), local anesthetic wound infiltration (ES, 0.29; 95% CI, 0.17-0.40), and NSAID administration (ES, 0.39; 95% CI, 0.27-0.48). Whereas preemptive epidural analgesia resulted in consistent improvements in all three outcome variables, preemptive local anesthetic wound infiltration and NSAID administration improved analgesic consumption and time to first rescue analgesic request, but not postoperative pain scores. The least proof of efficacy was found in the case of systemic NMDA antagonist (ES, 0.09; 95% CI, -0.03 to 0.22) and opioid (ES, -0.10; 95% CI, -0.26 to 0.07) administration, and the results remain equivocal.

Peripheral nerve blocks for postoperative pain after major knee surgery.

WITHDRAWN: Peripheral nerve blocks for postoperative pain after major knee surgery.

Local anesthetic infiltration prior to surgical incision closure is a frequently used technique in the operating room. Debate continues, with clinicians, as to the effectiveness of this technique in pain reduction. A literature review using PubMed with the criteria of anesthetic infiltration and pain was conducted for the use of local anesthetic infiltration prior to surgical closure. The search provided 137 results that were then categorized and reviewed, the studies that reviewed the effectiveness (pain reduction) of single dose infiltration of local anesthetics into the surgical wound was small, only numbering 23 studies. The use of local anesthetics before surgical incision or a continuous infusion of the local anesthetics into the surgical wound in the immediate post-operative period is more widely studied, but the effectiveness of this practice varies greatly between studies. The efficacy of using a single pre-closure local anesthetic infiltration ranged from producing a modest reduction in post-surgical pain to no change in post-surgical pain. This systematic review revealed that few studies have examined the effectiveness of local anesthetic infiltration into surgical incisions on post-operative pain outcomes and these results vary greatly as to the effectiveness of this surgical practice.

Introduction:The stripping of the densely innervated and inflamed parietal pleura in empyema during video-assisted thoracoscopic surgery (VATS) decortication can lead to significant pain and major postoperative respiratory compromise. Hence, we compared the analgesic efficacy of continuous epidural infusion versus local infiltration and systemic opioids in children undergoing VATS decortications.Methodology:Following ethics approval and informed consent, forty patients from 1 to 12 years of age were randomized into two groups, Group E (epidural) and Group L (local infiltration) after induction of anesthesia. In Group E, a thoracic epidural catheter was inserted between T4 and T8. A bolus dose of 0.5 ml/kg of 0.25% injection bupivacaine was given epidurally before incision. Postoperatively, the patients received epidural infusion with bupivacaine and fentanyl up to 48 h using an elastomeric balloon pump. In Group L, patients received local infiltration of bupivacaine (2 mg/kg) and lignocaine (5 mg/kg) at the port sites before incision and at the end of surgery. They also received injection tramadol 1 mg/kg intravenously TDS with thrice daily postoperatively. The pain scores (Face, Legs, Activity, Cry, Consolability/ Wong-Baker FACES scale) were assessed every 4 h on the 1st day and 6 h on the 2nd day. Injection diclofenac 1 mg/kg intravenous was used as a rescue analgesic for pain scores more than 4. Side effects such as nausea, vomiting, constipation, and motor blockade were noted. Quantitative and categorical data were assessed using t-test and Chi-square test, respectively.Results:The pain scores were lower in the epidural group than in the local infiltration group at 0, 4, and 20 h postoperatively (P = 0.001, 0.01, and 0.038, respectively). Seventeen out of nineteen patients required rescue analgesia in the local infiltration group in the postoperative period as compared to five patients in the epidural group with a P value of 0.000081.Conclusion:Epidural analgesia can be considered as an effective modality of reducing pain in patients undergoing VATS decortication for empyema in pediatric patients.

Background: This study compares the effects of epidural analgesia with infiltration analgesia in postoperative pain control for total knee arthroplasty. Materials and methods: 47 females and 13 males with an average age of 65.7 years were randomly allocated into epidural (EA; n=30) and local infiltration anesthesia (LIA; n=30) groups. All patients received spinal anesthesia and were inserted epidural catheter. In LIA group, 50mL of a mixture, containing bupivacaine, ketorolac, morphine sulfate, and epinephrine was injected in to periarticular tissue and in EA group normal saline was injected. In the EA group, after surgery, an epidural catheter was attached to the patient-controlled analgesia (PCA) infusion pump with 25cc bupivacaine diluted in 75mL of normal saline but in LIA group, the PCA pump of the epidural catheter contained 100cc of normal saline, and the pump was blocked.Results: The difference in demographic data was not significant between the groups. The mean VAS score (Pain) of EA group was significantly higher than LIA group until 12 hours after surgery, At 24 hours, there was no significant difference between two groups, and Pain of EA group was significantly lower than LIA group at 48 hours after the surgery. Dranage volume and hemoglobin drops were lower in LIA group. Knee range of motion in the LIA group was not superior to that of the EA group two weeks after surgery. The patients’ ability to perform active straight leg raise had no significant difference between two groups one day after the surgery.Conclusion: local infiltration analgesia is better than epidural for postoperative pain control at first 12 hours. However, epidural analgesia can control postoperative pain more effectively at 48 hours after surgery. There was no significantly difference between two groups regard to patients ability to perform straight leg rising and Knee range of motion was similar in two groups.