Abstract
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.
Highlights
Post-operative acute pain management is a major health issue and is costly to the health care system [1]
The included articles ranging in quality from poor to good and examined local anesthetic infiltration with a variety of local anesthetics (n=10 bupivacaine, n=4 ropivacaine, n=3 lidocaine articles), various surgical sites (n=9 tonsillectomy, n=4 iliac crest harvesting procedures, and n=1 saphenous vein stripping studies), a number of different pain outcomes (n=14 VAS, n=5 additional analgesic consumption), and large variations in clinical sample sizes (18-100 patients in a study)
The largest groups of studies were examining the effectiveness of local anesthetic infiltration on post-tonsillectomy pain
Summary
Post-operative acute pain management is a major health issue and is costly to the health care system [1]. The standard treatment for acute post-operative pain is the use of systemic opioids, but these are not without complications. There is growing use of i.v. acetaminophen post-operatively [4,5]. This practice limits the post-operative use of opioids and decreases opioid-induced adverse events [6]. The use of acetaminophen is to be used with caution in certain patient populations like those with hypervolemia related to dehydration or blood loss, those suffering from chronic alcoholism, chronic malnutrition and severe kidney impairment. I.v. acetaminophen is contraindicated in individuals with severe hepatic impairment [4,5]
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