Efficacy Of Local Anesthetic Infiltration Research Articles

Comparison Between Analgesic Effects of Pre-Operative and Post-Operative Trocar Site Infiltration of Injection Bupivacaine in Elective Laparoscopic Cholecystectomy

Objective: To compare the analgesic efficacy of Local Anaesthetic infiltration with Bupivacaine at Trocar site in Laporoscopic Cholecystectomy when injected preoperatively vs postoperatively. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General surgery, Combined Military Hospital, Rawalpindi Pakistan, from May to Nov, 2016. Patients and Methodology: Patients meeting the inclusion criteria were randomly divided into two groups using coin method. Group A received pre-operative injection of Bupivacaine infiltrated at the trocar sites. Patients in Group B received the similar dosage post-operatively. The pain of the patients was assessed post-operatively using Visual Analog Score (VAS) at 6, 12 and 24 hours and compared. Results: A total of 190 patients were equally divided into Group A and B (95 each). The mean age was 46±13.77 years in Group A and 43±14.80 years in Group B.23.68% (n=45) of patients were aged between 12-24 years, 13.15% (n=25) were of 25-36 years, 22.63% (n=43) were aged 37-48 years and 40.52% (n=77) of the patients were between the age of 49-60 years. 75.78% (n=144) of patients were males, while 24.21% (n=46) were females. The Mean±SD VAS post-operative pain scoring Group A and Group B was 4.5±0.04 vs 5.0± 0.40, respectively. The p-value was <0.001and the difference is statically significant. Conclusion: We concluded that the use of pre-operative local anesthesia helps reduce post-operative pain in patients undergoing laparoscopic cholecystectomy.

Comparison of Analgesic Efficacy of Local Anesthetic Infiltration and Ultrasound-guided Abdominal Wall Nerve Block in Children Undergoing Ambulatory Inguinal Hernia Repair

PurposePlacement of local anesthetics either as infiltration (LAI) or as abdominal wall nerve block (AWNB) has been shown to reduce postoperative pain following laparoscopic surgery. We aimed to compare intraoperative remifentanil consumption and postoperative pain of AWNB and LAI in children undergoing ambulatory two-port laparoscopic inguinal hernia surgery with propofol-remifentanil based general anesthesia. DesignRandomized controlled trial. MethodsChildren aged between 1 and 6 years undergoing two-port laparoscopic inguinal hernia repair were enrolled for analysis. These children received one of the three anesthesia regimens (1) standard general anesthesia (SGA); (2) SGA with preemptive LAI; (3) SGA with preemptive AWNB; and were categorized accordingly. Primary outcome variable were intraoperative average infusion rate of remifentanil and postoperative FLACC (Face, Legs, Activity, Cry, and Consolability) pain score. Secondary outcome data included demographics, intraoperative variables (hemodynamics and bispectral index score recorded at three different time points), and duration of surgery. FindingsA total of 90 children (30 in each group) were included in the analysis. General information, intraoperative hemodynamic variables, bispectral index score, and duration of surgery were not significantly different among groups. The intragroup variation of hemodynamic variables were less stable in the SGA group compared with the other two groups, while BIS score was similar among groups. The intraoperative infusion rate of remifentanil was significantly lower in the AWNB group than in the SGA or the LAI group (median [25th to 75th centiles]: 0.11[0.11 to 0.11] µg/kg/min, 0.33[0.33 to 0.33] µg/kg/min; 0.17[0.17 to 0.20] µg/kg/min, respectively, P < .001 for both), and lower in the LAI group than in the SGA group (P < .001). The postoperative FLACC pain score was significantly lower in the AWNB group than in the SGA or the LAI group (P < .001 for both). ConclusionsAWNB is associated with a lower intraoperative remifentanil requirement and a lower postoperative FLACC pain score compared with LAI in children undergoing laparoscopic inguinal hernia repair with propofol-remifentanil based general anesthesia.

PT112 - The efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control after tubeless percutaneous nephrolithotomy: A meta-analysis of randomised control trials

PT112 - The efficacy of local anesthetic infiltration around nephrostomy tract on postoperative pain control after tubeless percutaneous nephrolithotomy: A meta-analysis of randomised control trials

Re: Comment on: Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy.

OBJECTIVE This study aimed to compare the efficacy of local anaesthetic infiltration to trocar wounds and intraperitoneally on postoperative pain as a part of a multimodal analgesia method after laparoscopic cholecystectomies. METHODS The study was performed on 90 ASA I-III patients aged between 20 and 70 years who underwent elective laparoscopic cholecystectomy. All patients had the same general anaesthesia drug regimen. Patients were randomized into three groups by a closed envelope method: group I (n=30), trocar site local anaesthetic infiltration (20 mL of 0.5% bupivacaine); group II (n=30), intraperitoneal local anaesthetic instillation (20 mL of 0.5%) and group III (n=30), saline infiltration both trocar sites and intraperitoneally. Postoperative i.v. patient controlled analgesia was initiated for 24 h. In total, 4 mg of i.v. ondansetron was administered to all patients. Visual analogue scale (VAS), nausea and vomiting and shoulder pain were evaluated at 1., 2., 4., 8., 12., 24. hours. An i.v. nonsteroidal anti-inflammatory drug (NSAID) (50 mg of dexketoprofen) as a rescue analgesic was given if the VAS was ≥5. RESULTS There were no statistical significant differences between the clinical and demographic properties among the three groups (p≥0.005). During all periods, VAS in group I was significantly lower than that in groups II and III (p<0.001). Among the groups, although there was no significant difference in nausea and vomiting (p=0.058), there was a significant difference in shoulder pain. Group III (p<0.05) had more frequent shoulder pain than groups I and II. The total morphine consumption was higher in groups II and III (p<0.001 vs p<0.001) than in group I. The requirement for a rescue analgesic was significantly higher in group III (p<0.05). CONCLUSION Trocar site local anaesthetic infiltration is more effective for postoperative analgesia, easier to apply and safer than other analgesia methods. Morphine consumption is lesser and side effects are fewer; therefore, this method can be used as a part of common practice.

Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy

This study aimed to compare the efficacy of local anaesthetic infiltration to trocar wounds and intraperitoneally on postoperative pain as a part of a multimodal analgesia method after laparoscopic cholecystectomies. The study was performed on 90 ASA I-III patients aged between 20 and 70 years who underwent elective laparoscopic cholecystectomy. All patients had the same general anaesthesia drug regimen. Patients were randomized into three groups by a closed envelope method: group I (n=30), trocar site local anaesthetic infiltration (20 mL of 0.5% bupivacaine); group II (n=30), intraperitoneal local anaesthetic instillation (20 mL of 0.5%) and group III (n=30), saline infiltration both trocar sites and intraperitoneally. Postoperative i.v. patient controlled analgesia was initiated for 24 h. In total, 4 mg of i.v. ondansetron was administered to all patients. Visual analogue scale (VAS), nausea and vomiting and shoulder pain were evaluated at 1., 2., 4., 8., 12., 24. hours. An i.v. nonsteroidal anti-inflammatory drug (NSAID) (50 mg of dexketoprofen) as a rescue analgesic was given if the VAS was ≥5. There were no statistical significant differences between the clinical and demographic properties among the three groups (p≥0.005). During all periods, VAS in group I was significantly lower than that in groups II and III (p<0.001). Among the groups, although there was no significant difference in nausea and vomiting (p=0.058), there was a significant difference in shoulder pain. Group III (p<0.05) had more frequent shoulder pain than groups I and II. The total morphine consumption was higher in groups II and III (p<0.001 vs p<0.001) than in group I. The requirement for a rescue analgesic was significantly higher in group III (p<0.05). Trocar site local anaesthetic infiltration is more effective for postoperative analgesia, easier to apply and safer than other analgesia methods. Morphine consumption is lesser and side effects are fewer; therefore, this method can be used as a part of common practice.

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.

Seeing Eye to Eye on Ophthalmic Regional Anesthesia

University of Miami, Bascom Palmer Eye Institute, Miami, Florida. hpalte@med.miami.edu1The review article on ophthalmic regional anesthesia by Nouvellon et al. 1was engaging, particularly the cadaver photographs elucidating the spread of local anesthetic agent within the orbit as well as the links to supplemental digital content.The authors are to be commended for their comprehensive discourse. However, their assertions regarding akinesia, reproducibility, and reblock rates for peribulbar (extraconal) anesthesia require greater clarification. A review of the literature, more current than quoted in their report, suggests the statement “an additional injection is required in as many as 50% of cases” may be misleadingly excessive.2–4The efficacy and low complication rate of extraconal ophthalmic blockade is well documented. In a group of 200 patients, Ghali and Hafez2compared 5–7 ml peribulbar anesthesia using a single inferotemporal injection or a combined inferotemporal/superomedial technique. The reinjection rates for these two groups were 7% and 16%, respectively. Clausel et al. 3also evaluated single-shot peribulbar anesthesia for cataract surgery using local anesthetic volumes of 5–6 ml. Ninety of their 101 patients had complete akinesia at 10 min, and surgical conditions were deemed good in all cases. Similarly, Rizzo et al. ,4in a sample of 857 patients, evaluated the efficacy of a single injection of 2% lidocaine adopting a medial percutaneous approach. Akinesia was reportedly attained in 85.6% of patients 2 min after injection. Furthermore, surgical anesthesia was adequate in 100% of cases within 7 min, and no patients required block supplementation. By contrast, Luchetti et al. 5compared the efficacy of ropivacaine 0.75% and bupivacaine 0.5%-mepivacaine 2% in a study sample of 2,000 patients. They achieved satisfactory sensory blockade in all cases but noted a reinjection rate of 30–34% to attain complete eye immobility.In terms of akinesia and reproducibility, the ultimate efficacy of local anesthetic infiltration into the extraconal space (peribulbar ophthalmic anesthesia) is governed by a number of factors. These include technique style (e.g. , intraorbital position of needle tip), composition of local anesthetic solution, use of the spreading agent hyaluronidase, and the nature and duration of the specific ophthalmic surgical procedure.University of Miami, Bascom Palmer Eye Institute, Miami, Florida. hpalte@med.miami.edu

Prospective, Double-Blinded, Randomized, Placebo-Controlled Comparison of Local Anesthetic and Nonsteroidal Anti-Inflammatory Drugs for Postoperative Pain Management after Laparoscopic Surgery

Compared with the open approach, laparoscopy has been shown to significantly reduce postoperative pain. Improving postoperative analgesia in laparoscopic surgery is an area of continued interest. The goal of this study was to compare the efficacy of local anesthetic infiltration with or without preoperative nonsteroidal anti-inflammatory drugs. Patients undergoing elective laparoscopic cholecystectomy were enrolled in an Institutional Review Board-approved, prospective, double-blinded, randomized, placebo-controlled comparison study. Patients were randomized into four groups: Group I, preoperative oral administration of a placebo medication and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine at trocar sites; Group II, preoperative oral administration of 50 mg of rofecoxib; Group III, preoperative oral administration of 50 mg of rofecoxib and preincision local infiltration of 40 mL of 0.5 per cent bupivicaine into skin, muscle, and peritoneum; and Group IV, preoperative oral administration of a placebo medication. Postoperative pain scores were assessed at 4 hours, 8 hours, 12 hours, and 24 hours using a visual analog scale. Postoperative analgesic use, complications, and length of stay were recorded. Statistical significance was defined as P < 0.05. Fifty-five patients (46 women and 9 men) were enrolled in this study and underwent a standardized, elective, laparoscopic cholecystectomy for mild, symptomatic cholelithiasis (96.4%) and gallbladder polyps (3.6%). No patient had pain immediately before surgery. Postoperative analgesic requests, visual analog scale results, incidence of postoperative vomiting at 4 hours, 8 hours, 12 hours, and 24 hours, in addition to length of stay, were not statistically different between the four groups. No complications occurred. The use of preoperative rofecoxib, 0.5 per cent bupivicaine infiltration, or both for postoperative analgesia did not decrease postoperative pain or decrease length of stay after laparoscopic cholecystectomy compared with placebo. Preoperative administration of an oral anti-inflammatory pain medication, infiltration of a local anesthetic, or both had no greater effect than placebo in controlling discomfort after a laparoscopic cholecystectomy. The challenge of preempting postoperative pain continues and will require further investigation.

Prospective randomized trial to evaluate effectiveness of periprostatic nerve block in prostatic biopsy

Objectives: The objective of the study was to evaluate the efficacy of local anesthetic infiltration, in decreasing the discomfort experienced by patients undergoing trans-rectal ultrasound (TRUS) guided biopsy of prostate. Materials and methods: Between January 2002 and February 2003, we investigated consecutively, asymptomatic men, suspected of having prostatic cancer. About 39 patients were randomized to receive 10 ml of 2% Lidocaine periprostatic block + intrarectal Lidocaine gel (group 1 = 20), or intarectal Lidocaine gel only (group 2 = 19) during prostatic biopsy. Immediately following the TRUS-guided biopsy, patients were asked to grade the pain they experienced using the 11-point visual analogue score (VAS). Results: The mean pain score in the patients of group 1 were significantly lower than the patients of group 2 ( P <0.001), suggesting that periprostatic block produced a significant reduction in the perceived pain. Conclusions: Local anesthetic infiltration by TRUS-guided injection of Lidocaine is effective for decreasing pain associated with prostatic biopsy.

Effect of Administration of Ketorolac and Local Anaesthetic Infiltration for Pain Relief after Laparoscopic-assisted Vaginal Hysterectomy

The efficacy of local anaesthetic infiltration and/or non-steroidal anti-inflammatory drugs for post-operative analgesia following laparoscopic-assisted vaginal hysterectomy (LAVH) was investigated in 83 patients, randomized into four groups in this double-blind, placebo-controlled study: group BK, local infiltration with bupivacaine and pre-incisional intramuscular (IM) ketorolac; group NN, saline local infiltration IM; group BN, local infiltration with bupivacaine and saline IM; group NK, local infiltration with saline and ketorolac IM. Post-operative pain scores were assessed at 1 h, 3 h, 6 h, 12 h and 24 h using a visual analogue scale (VAS). The major pain site, first analgesic request time and incidence of analgesic requests were also recorded. At 1 h, 3 h and 6 h after surgery, group BK patients had significantly lower VAS pain scores than group NN patients. The first analgesic request time was significantly longer in group BK than in groups NN, BN and NK. Pre-incisional treatment with ketorolac IM and local infiltration with bupivacaine reduced post-operative pain after LAVH.

Effective Analgesia After Bilateral Tubal Ligation

Postpartum bilateral tubal ligation is a brief surgical procedure with minimal tissue injury, yet postoperative recovery times and analgesia requirements are often disproportionately large.To evaluate the analgesic efficacy of local anesthetic infiltration, 20 parturients scheduled for elective minilaparotomy and bilateral tubal ligation with either spinal or epidural anesthesia participated in this prospective, randomized, controlled, double-blind trial. All patients received IV metoclopramide 10 mg and ketorolac 60 mg intraoperatively, as well as preincisional infiltration of the infraumbilical skin incision with 0.5% bupivacaine. Infiltration of bilateral uterine tubes and mesosalpinx was performed with either 0.5% bupivacaine (n = 10) or isotonic sodium chloride solution (saline) (n = 10). IV meperidine (25 mg every 3 min as needed) was given to treat pain in the postanesthesia care unit (PACU). The total amount of meperidine administered in the PACU was significantly larger in the saline group than in the bupivacaine group. Pain scores at 30, 45, 60, 75, and 90 min postoperatively and on the seventh postoperative day were significantly lower in the bupivacaine group than in the saline group. During tubal ligation, infiltration of uterine tubes and mesosalpinx with 0.5% bupivacaine significantly enhanced analgesia both in the immediate postoperative setting and on the seventh postoperative day compared with infiltration with sodium chloride. Implications: During bilateral tubal ligation with either spinal or epidural anesthesia, preemptive analgesia using IV ketorolac, IV metoclopramide, and infiltration of the incised skin and uterine tubes with 0.5% bupivacaine allowed 9 of 10 patients to recover with no pain, nausea, vomiting, or cramping and to maintain good analgesia for 7 days postoperatively. (Anesth Analg 1998;87:619-23)