Effect Of Local Anaesthetic Infiltration Research Articles

Surgical and anesthetic considerations in a unique case of temporary iatrogenic facial nerve paralysis after superficial parotidectomy

Parotid neoplasms are a common indication for parotidectomy, a procedure that carries a risk of facial paralysis. Modern advances in surgical and anesthesia techniques, including facial nerve monitoring have resulted in low rates of permanent facial nerve paralysis. We present a case of temporary postoperative right facial nerve paralysis after intact facial nerve neuromonitoring at the completion of resection. The proposed mechanism of this phenomenon is related to the effects of local anesthetic infiltration from a fat graft used for oncologic reconstruction. This case emphasizes the importance of judicious and carefully timed local anesthetic use, clear facial nerve monitoring, and coordination between care teams.

Effect of local anaesthetic infiltration on postoperative pain after laparoscopic cholecystectomy: Randomized clinical trial

Wikran SURAGUL, Narongsak RUNGSAKULKIJ, Apawee TANTAWANIT, Paramin MUANGKAEW, Somkit MINGPHRUDHI, Watoo VASSANASIRI, Panuwat LERTSITHICHAI, Suraida AEESOA, Worapot APINYACHON*. Ann Hepatobiliary Pancreat Surg 2023;27:S259. https://doi.org/10.14701/ahbps.2023S1.BP-PP-7-5

Effect of local anaesthetic infiltration on postoperative pain after laparoscopic cholecystectomy: randomized clinical trial.

BackgroundLocal anaesthetic infiltration is widely used to reduce pain after laparoscopic cholecystectomy (LC). This trial evaluated the effect of depth of local anaesthetic infiltration on postoperative pain reduction after LC.MethodsPatients undergoing elective LC between March 2018 and February 2019 were randomized into no infiltration, subcutaneous infiltration, and rectus sheath infiltration using bupivacaine. The primary outcome was 24-h postoperative cumulative morphine use, and the secondary outcomes were mean 24-h Numerical Rating Scale (NRS) for pain, and nausea, and vomiting. Subgroups were compared and multivariable analyses were performed.ResultsOut of 170 eligible patients, 162 were selected and 150 patients were analysed: 48 in the no-infiltration group, 50 in the subcutaneous infiltration group, and 52 in the rectus sheath infiltration group. The groups had similar clinical features, although mean BMI was higher in the subcutaneous infiltration group (P = 0.001). The 24-h cumulative morphine use in the rectus sheath infiltration group was significantly lower than in the no-infiltration group (P = 0.043), but no difference was observed between the subcutaneous infiltration and no-infiltration groups (P = 0.999). One hour after surgery, the rectus sheath infiltration group had a significantly lower NRS score than the no-infiltration and subcutaneous infiltration groups respectively (P = 0.006 and P = 0.031); however, the score did not differ among the three groups at any of the time points from 2 h after the surgery. The incidence of nausea or vomiting was comparable among the three groups. Multivariable analysis documented that a lower dose of morphine use was associated with rectus sheath infiltration (P = 0.004) and diabetes (P = 0.001); whereas, increased morphine use was associate with age (P = 0.040) and a longer duration of surgery (P = 0.007).ConclusionsLocal anaesthetic infiltration into the rectus sheath reduced postoperative cumulative morphine use and the immediate NRS score in patients undergoing LC; however, the pain scores were comparable 2 h after surgery.Registration numberTCTR20201103002 (http://www.thaiclinicaltrials.org).

Effect of Local Anesthetic Infiltration on Postoperative Pain Control after Laparoscopic Cholecystectomy, a Randomized Controlled Trial

Introduction: Local anesthetic wound infiltration are widely used in laparoscopic cholecystectomy (LC) for postoperative pain control but an effectiveness is still debatable. This study aims to investigate an effect of a different depth of local anesthetic wound infiltration on postoperative pain.

The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis

Objectives: To assess the safety and efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy. Methods: This systematic review was performed based on randomized clinic trials about local anesthetic infiltration around nephrostomy tract on postoperative pain control. The weighted mean difference (WMD), with their corresponding 95% CI, was calculated to compare continuous variables. Results: Our results showed that the consumption of analgesic was less in the experimental group than in the control group (WMD -25.32, 95% CI -48.09 to -2.55, p = 0.003). There was no significant difference between the mean Visual Analog Scale (VAS) in the experimental group than the control group after 6 h while significantly lower after 24 h. The time of first analgesic demand was significantly longer in the experimental group (WMD 2.19, 95% CI 0.98-3.41). There was no significant difference between 2 groups in terms of operation time, hemoglobin (Hb) alteration, and hospital stay. Conclusion: Local anesthetic infiltration around nephrostomy tract had similar efficacy in the control group in terms of operation time, Hb alteration, and hospital stay, but offers some potential advantages in terms of analgesia requirement, the time of first analgesic demand, and VAS-24 h. However, good quality and large studies with long-term follow-up are warranted for further research.

Effect of local anaesthetic infiltration on chronic postsurgical pain after total hip and knee replacement: the APEX randomised controlled trials.

Total hip replacement (THR) and total knee replacement (TKR) are usually effective at relieving pain; however, 7% to 23% of patients experience chronic postsurgical pain. These trials aimed to investigate the effect of local anaesthetic wound infiltration on pain severity at 12 months after primary THR or TKR for osteoarthritis. Between November 2009 and February 2012, 322 patients listed for THR and 316 listed for TKR were recruited into a single-centre double-blind randomised controlled trial. Participants were randomly assigned (1:1) to receive local anaesthetic infiltration and standard care or standard care alone. Participants and outcomes assessors were masked to group allocation. The primary outcome was pain severity on the WOMAC Pain Scale at 12 months after surgery. Analyses were conducted using intention-to-treat and per-protocol approaches. In the hip trial, patients in the intervention group had significantly less pain at 12 months postoperative than patients in the standard care group (differences in means: 4.74; 95% confidence interval [CI]: 0.95-8.54; P = 0.015), although the difference was not clinically significant. Post hoc analysis found that patients in the intervention group were more likely to have none to moderate pain than severe pain at 12 months than those in the standard care group (odds ratio: 10.19; 95% CI: 2.10-49.55; P = 0.004). In the knee trial, there was no strong evidence that the intervention influenced pain severity at 12 months postoperative (difference in means: 3.83; 95% CI: -0.83 to 8.49; P = 0.107). In conclusion, routine use of infiltration could be beneficial in improving long-term pain relief for some patients after THR.

The effect of local anesthetic infiltration around nephrostomy tract on postoperative pain control after percutaneous nephrolithotomy.

The objective of the study was to investigate the effect of a long acting local anesthetic infiltration around nephrostomy tract on pain control after percutaneous nephrolithotomy. Forty-six patients with kidney stones of >2 cm undergoing single access subcostal percutaneous nephrolithotomy (PCNL) were enrolled in the study. Patients were randomized to levobupivacaine (Group I) and saline (Group II) infiltration groups. Group I patients (n = 23) had 75 mg/30 cc levobupivacaine infiltration around the access site after placement of nephrostomy catheter. Group II patients had 30 cc saline infiltration. Postoperatively the patients were given narcotics on demand. Pain scores were collected using a visual analog scale (VAS) at 2, 4, 6, 8, 12 and 24 h postoperatively. The VAS scores, time to analgesic demand, ambulation, and duration of nephrostomy tube were compared between two groups. The mean age was 44 and 45 years in group I and II patients. There were no significant differences between the two groups with regard to demographics, surgery or stone characteristics. Comparison of pain scores at all postoperative time points was not statistically significant between the two groups. Time to first analgesic demand and total narcotic analgesic dose per patient were 1.2 ± 1.05 and 4.04 ± 1.57 h; and 96 and 112 mg for group I and II patients (p = 0.009 and p = 0.41, respectively). Ambulation time and duration of nephrostomy tube were also similar. Infiltration of nephrostomy tract site with levobupivacaine does not have a superior effect compared to saline on postoperative pain control in patients undergoing PCNL.To prolong analgesia, the effect of intermittent tract injections or continuous infusion of local anesthetics for the postoperative maintenance of the local anesthetic effect seems worth to investigate in future studies.

Local anesthetic wound infiltration for pain management after periacetabular osteotomy

Background and purpose — To our knowledge, there is no evidence to support the use of local infiltration analgesia (LIA) for postoperative pain relief after periacetabular osteotomy (PAO). We investigated the effect of wound infiltration with a long-acting local anesthetic (ropivacaine) for postoperative analgesia after PAO.Patients and methods — We performed a randomized, double-blind, placebo-controlled trial (ClinicalTrials.gov: NCT00815503) in 53 patients undergoing PAO to evaluate the effect of local anesthetic infiltration on postoperative pain and on postoperative opioid consumption. All subjects received intraoperative infiltration followed by 5 postoperative injections in 10-hour intervals through a multi-holed catheter placed at the surgical site. 26 patients received ropivacaine and 27 received saline. The intervention period was 2 days and the observational period was 4 days. All subjects received patient-controlled opioid analgesia without any restrictions on the total daily dose. Pain was assessed at specific postoperative time points and the daily opioid usage was registered.Results — Infiltration with 75 mL (150 mg) of ropivacaine did not reduce postoperative pain or opioid requirements during the first 4 days.Interpretation — The clinical importance of ropivacaine as single component in postoperative treatment of pain is questionable, and we are planning further studies to explore the potential of LIA in larger volume—and also a multimodal regimen—to treat pain in this category of patients.

Effect of local anaesthetic infiltration with bupivacaine and ropivacaine on wound healing: a placebo‐controlled study

Infiltration of surgical wounds with long-acting local anaesthetics (LA) is used to reduce postoperative incisional pain. We hypothesised that infiltration with LA interferes with wound healing in rats. Seventy-two rats were allocated into nine groups. After intraperitoneal anaesthesia, the interscapular dorsal region was infiltrated with equivolumes of saline, 0·5% bupivacaine or ropivacaine, in a randomised double-blind fashion. A standardised incision was performed in the infiltrated area and sutured closed. The rats were euthanised on the 3rd or 14th day after the operation and tissue from the incision site was subjected to histochemical analyses and mechanical testing (MT). Compared with the control group, bupivacaine displayed a significant increase in the macrophage number on day 3 (+63% versus +27% for ropivacaine). The transforming growth factor β-1 expression had a significant increase in the LA (versus saline) groups, +63% in ropivacaine group and +115% in bupivacaine group on day 3 (P < 0·05). The collagen fibres as measured by dyed area were significantly higher in the bupivacaine group on day 3 (+56%, P < 0·01 versus +15% for ropivacaine). CD34 was reduced in bupivacaine group (-51%, P < 0·05 versus +3% for ropivacaine). On day 14, no statistical differences were observed in either LA group (versus saline) with respect to histopathologic or inflammatory mediators. MT on day 14 showed no differences between the LA and saline groups. The LA-induced increases in histological markers did not extend beyond the third day, suggesting that wound infiltration with long-acting LA does not impair the wound healing process in rats.

Local Anaesthesia Efficacy as Postoperative Analgesia for Open Shoulder Instability Surgery: A Prospective Randomised Controlled Study

Background and objectives: The aim of present study was to evaluate for the first time, the clinical effect of local anaesthetic infiltration as postoperative analgesia in open shoulder surgery for anterior-inferior instability. The comparison of the local infiltration and interscalenic brachial plexus block to a control group test the local anaesthetic efficacy in this surgery. Methods: 78 patients scheduled for open shoulder surgery were enrolled and randomly assigned to one of three groups: local infiltration anaesthesia (LIA), interscalenic brachial plexus block (IBPB) and control (C). All patients received standardized general anaesthesia and all injections were performed with the same dose and volume of anaesthetic. The number boluses delivered by a PCA pump applied at the end of surgery and the visual analogue score (VAS) at 0, 2, 4, 6, 12, 18 and 24 hours after intervention were recorded. A patient satisfaction score was also assessed.

A double blind randomized trial of wound infiltration with ropivacaine after breast cancer surgery with axillary nodes dissection

BackgroundThe effect of local infiltration after breast surgery is controversial. This prospective double blind randomized study sought to document the analgesic effect of local anaesthetic infiltration after breast cancer surgery.MethodsPatients scheduled for mastectomy or tumorectomy and axillary nodes dissection had immediate postoperative infiltration of the surgical wound with 20 ml of ropivacaine 7.5 mg.ml-1 or isotonic saline. Pain was assessed on a visual analogue scale at H2, H4, H6, H12, H24, H72, and at 2 month, at rest and on mobilization of the arm. Patient'comfort was evaluated with numerical 0-3 scales for fatigue, quality of sleep, state of mood, social function and activity.ResultsTwenty-two and 24 patients were included in the ropivacaine and saline groups respectively. Postoperative pain was lower at rest and on mobilization at 2, 4 and 6 hour after surgery in the ropivacaine group. No other difference in pain intensity and patient 'comfort scoring was documented during the first 3 postoperative days. Patients did not differ at 2 month for pain and comfort scores.ConclusionSingle shot infiltration with ropivacaine transiently improves postoperative pain control after breast cancer surgery.Trial registration numberNCT01404377

Local Anaesthetic Wound Infiltration after Internal Fixation of Femoral Neck Fractures: A Randomized, Double-Blind Clinical Trial in 33 Patients

Pain control may assist early mobilisation after internal fixation of femoral neck fractures. Systemic opioids have significant side effects in elderly patients. We present an evaluation of the effect of local anaesthetic infiltration in such cases , the objective being to decrease the need for postoperative opioids and to improve pain control for patients after surgery. 33 patients undergoing internal fixation with 2 parallel hook pins were randomized into 2 groups in a double blind study (ClinicalTrials.gov: NCT00529425). 33 patients received intraoperative infiltration followed by 6 postoperative injections through an intraarticular catheter in eight-hour intervals. 19 patients received ropivacaine and 14 received saline. The intervention period was 48 hours and the observation period was 5 days. In both groups there were no restrictions on the total daily dose of rescue analgesics. Pain was assessed at specific postoperative time-points and the daily consumption of opioid drugs needed for analgesia was registered. There was no significantly reduced consumption of standardized opioid rescue analgesics or pain in the study group receiving ropivacaine injections. Apart from a reduction in nausea in the study group on the second postoperative day, there were no significant differences in the occurrence of side effects between the groups. On day 2 the placebo group had less pain than the study group. Local anaesthetic infiltration after fixation of femoral neck fractures does not reduce opioid consumption or pain'.

Points for Clarification

I read this paper with interest and congratulate the operating surgeon on his low cranial nerve injury rates. I would be grateful for clarification regarding the following issues. Why were there 225 exclusions? Did the cranial nerve injuries occur early in the series or late and were they the reason for the stated change in approach? What is meant by ‘targeted follow-up’ and how long did the injuries take to resolve (i.e. was this a reflection of the effect of local anaesthetic infiltration or tension neuropraxia)? Why was the chi-squared test used for such small numbers of complications? First, the Fisher' exact test might have been more appropriate, and second there is the risk of confusing clinically significant differences with statistically significant differences. This is relevant in the consideration of haematoma (no statistically significant difference in proportions). Were the necks re-explored (a clinically significant outcome not commented upon) and, if so, was there a clear cause for the haematoma that would differ between the groups (e.g. a slipped ligature on the facial vein)? I agree with the conclusion that a much larger series would be needed to evaluate fully the difference in rates of nerve injury complications, but would suggest that a better conclusion would be that, in experienced hands, local anaesthetic carotid endarterectomy has a very low rate of permanent cranial nerve injury irrespective of approach.

The effect of local anaesthetic infiltration on urethral function during the tension-free vaginal tape (TVT) procedure

Different anaesthetic techniques are used for the tension-free vaginal tape (TVT) procedure. Using local anaesthetic and spinal techniques allows surgeons to adjust sling tension with the cough test. The aim of this study was to asses whether the periurethral infiltration of the local anaesthetic technique for TVT results in a significant alteration in urethral function. Twenty-five women who underwent a TVT procedure for stress incontinence were studied prospectively. Urethral function was assessed with the urethral retro-resistance pressure (URP) before and after the infiltration of local anaesthetic. Paired t tests were used to compare values. The mean URP value was 48.0 cm/H2O (SD, 18.4) before and 52.0 cm/H2O (SD, 34.5) after the periurethral infiltration of local anaesthetic. There was no statistical significance between the two groups (p = 0.37). Local anaesthetic does not alter urethral function, as measured by URP, allowing coughing to mimic non-anaesthetic conditions.

Adverse effects of local anesthetic infiltration on wound healing

Adverse effects of local anesthetic infiltration on wound healing

Adverse Effects of Local Anesthetic Infiltration on Wound Healing

Adverse Effects of Local Anesthetic Infiltration on Wound Healing

Local Dental Anaesthesia and Evidential Breath Testing: The Effect of Injection of Local Anaesthetic on Lip Seal

The effect of local anaesthetic infiltration on the ability of subjects to provide adequate specimens of breath for analysis using an evidential breath testing device was assessed. The results showed that in ten out of the fourteen cases there was no impairment of the ability to provide the specimens of breath at any time. Within two hours of the administration of a local anaesthetic all subjects were able to provide the requisite samples.

Effects of local anesthetic infiltration on brain potentials evoked by painful dental stimulation : Anesth. Analg. Curr. Res., 60 (1981) 779–782

Pain: February 1982 - Volume 12 - Issue 2 - p 190 doi: 10.1016/0304-3959(82)90207-X

Effects of Local Anesthetic Infiltration on Brain Potentials Evoked by Painful Dental Stimulation

The effects of lidocaine 2% infiltration on the brain-evoked potential elicited by painful dental stimulation were observed in human subjects. Both the evoked potential wave form and the subjective pain were eliminated by the local anesthetic in 10 volunteers, whereas saline infiltration under identical conditions in 10 others had no effect. These results support our other observations which indicate that brain-evoked potentials recorded during painful dental stimulation are a reliable physiologic correlate of human pain.