Intraoperative Wound Infiltration Research Articles

Lidocaine vs. tramadol vs. placebo wound infiltration for post-cesarean section pain relief: a randomized controlled trial.

In low-income settings, postoperative pain relief could be challenging as a high patient/nurse ratio limits pain assessment and adequate analgesics administration. The multi-center prospective double-blinded parallel randomized controlled trial was done to compare lidocaine, tramadol, and placebo (saline) intraoperative wound infiltration to relieve post-cesarean section wound pain during the first 24h. Ninety-nine cases were equally randomized into three groups, each containing 33 pregnant women undergoing cesarean section under general anesthesia. During operation, the wound was infiltrated subcutaneously with 20mL of 2% lidocaine solution in the first group, 2mg/kg tramadol in the second group, and saline in the third group. The primary outcome was to assess the postoperative pain at 2, 4, 6, 12, and 24h by the Yes-No-Don't Know (YNDK) Scale, while the secondary outcome was to assess the need for further postoperative analgesia. Wound infiltration with lidocaine or tramadol was effective in pain relief, and both were superior to placebo. Wound infiltration with tramadol was superior to lidocaine in pain relief at 2h and up to 24h. Wound infiltration with tramadol has a more prolonged pain relief effect than lidocaine in post-cesarean section pain relief in patients performing cesarean section under general anesthesia lasting up to 24h, and both are superior to placebo in pain relief.

Effect of Multimodal Drugs Infiltration on Postoperative Pain in Split Laminectomy of Lumbar Spine: A Randomized Controlled Trial.

A randomized, double-blinded controlled trial. This study tested the effect of single-dose wound infiltration with multiple drugs for pain management after lumbar spine surgery. Patients undergoing spine surgery often experience severe pain especially in early postoperative period. We hypothesized that intraoperative wound infiltration with multiple drugs would improve outcomes in lumbar spine surgery. Fifty-two patients who underwent one to two levels of spinous process splitting laminectomy of lumbar spine, were randomized into two groups. Infiltration group received intraoperative wound infiltration of local anesthetics, morphine sulfate, epinephrine, and nonsteroidal anti-inflammatory drugs at the end of surgery, and received patient-controlled analgesia (PCA) postoperatively. The control group received only PCA postoperatively. The primary outcome measures were amount of morphine consumption and visual analogue scale (VAS) for pain. The secondary outcome measures were Oswestry Disability Index (ODI), Roland-Morris Low Back Pain and Disability Questionnaire (RMDQ), patient satisfaction, length of hospital stay, and side effects. A total of 49 patients (23 patients for local infiltration group, and 26 patients for control group) were analyzed. There were statistically significant [P < 0.001, the effect size -5.0, 95% CI (-6.1, -3.9)] less morphine consumptions in the local infiltration group than the control group during the first 12 hours, 12 to 24 hours, and 24 to 48 hours after surgery. The VAS of postoperative pain reported by patients at rest and during motion was significantly lower in the local infiltration group than the control group at all assessment times (P < 0.001). The effect size of VAS of postoperative pain at rest and during motion were -2.0, 95% CI (-2.5, -1.4) and -2.0, 95% CI (-2.6, -1.4) respectively. ODI and RMDQ at 2 week and 3 month follow-ups in both groups had significant improvement from baseline (P < 0.001). No significant differences were found between groups (P = 0.262 for ODI and P = 0.296 for RMDQ). There were no significant differences of patient satisfaction, length of stay, and side effects between both groups (P = 0.256, P = 0.262, P = 0.145 respectively). Intraoperative wound infiltration with multimodal drugs reduced postoperative morphine consumption, decreased pain score with no increased side effects. 1.

Intraoperative wound infiltration with local anesthetic in open abdominal hysterectomy significantly reduces postoperative opioid consumption (wound infiltration)

Intraoperative wound infiltration with local anesthetic in open abdominal hysterectomy significantly reduces postoperative opioid consumption (wound infiltration)

The late effect of intraoperative wound infiltration with local anaesthetic in surgical patients; is there any? A randomized control trial

IntroductionIntraoperative wound infiltration with local anaesthetic is commonly used. Apart from the obvious immediate action it has been supported that a possible down regulation of pain receptors may lead to longer effects. Our aim was to compare the use of local anaesthetic versus placebo in order to assess if indeed there is a late beneficial effect. MethodsWe conducted an RCT involving 400 consecutive general surgery patients randomized in 2 groups: Group A = placebo, Group B = wound infiltration with 15 ml of ropivacaine 10%. We recorded the preoperative and postoperative pain for the 1st week as well as the type and quantity of the analgesia used during the study period. ResultsNo significant difference was found between the groups in all known confounding factors recorded. No significant difference was found in the intensity of postoperative pain. More people of group A required NSAIDs during the first 3 PO days while more people of Group B required stronger painkillers. For those patients who underwent a non urgent operation and especially laparoscopic surgery higher pain score was recorded in the group B from the 3rd PO day onwards. DiscussionIntraoperative local infiltration of the wound with local anaesthetic offers no further benefit for the general surgery apart from that of the immediate PO period. There is no late effect for pain control. Considering that during the immediate postoperative period stronger systematic painkillers are given the intraoperative, infiltration of the wound with the local anaesthetic under study offers no obvious benefit.

Peripheral nerve catheters and local anesthetic infiltration in perioperative analgesia

Peripheral nerve catheters (PNCs) and local infiltration analgesia (LIA) represent valuable options for controlling perioperative pain. PNCs have been increasingly utilized to provide both surgical anesthesia and prolonged postoperative analgesia for a wide variety of procedures. PNCs can be more technically challenging to place than typical single-injection nerve blocks (SINB), and familiarity with the indications, contraindications, relevant anatomy, and appropriate technical skills is a prerequisite for the placement of any PNC. PNCs include risks of peripheral nerve injury, damage to adjacent anatomic structures, local anesthetic toxicity, intravascular injection, risks associated with motor block, risks of unnoticed injury to the insensate limb, and risks of sedation associated with PNC placement. In addition to these common risks, there are specific risks unique to each PNC insertion site. LIA strategies have emerged that seek to provide the benefit of targeted local anesthesia while minimizing collateral motor block and increasing the applicability of durable local anesthesia beyond the extremities. LIA involves the injection and/or infusion of a local anesthetic near the site of surgical incision to provide targeted analgesia. A wide variety of techniques have been described, including single-injection intraoperative wound infiltration, indwelling wound infusion catheters, and the recent high-volume LIA technique associated with joint replacement surgery. The efficacy of these techniques varies depending on specific procedures and anatomic locations. The recent incorporation of ultra-long-acting liposomal bupivacaine preparations has the potential to dramatically increase the utility of single-injection LIA. LIA represents a promising yet under-investigated method of postoperative pain control.

Prevention of Chronic Postsurgical Pain

Prevention of Chronic Postsurgical Pain

Serum and Wound Drain Ropivacaine Concentrations After Wound Infiltration in Joint Arthroplasty

Ropivacaine blood and drain levels were measured in 20 hip and 15 total knee arthroplasties after intraoperative wound infiltration with 150 to 200 mL (360-400 mg) of ropivacaine, followed by a 48-hour intra-articular pain pump infusion of 1000 mg (knees) and 300 mg (hips) commencing 12 hours postoperatively. Concentrations were below 2 μg/mL over the first 12 hours before the pain pump increased levels. Peak total ropivacaine concentration ranged from 0.65 to 4.36 μg/mL with the pain pump. The high infiltration doses produced levels below or within the safe threshold of 1 to 3 μg/mL. Pain pump infusion produced some C max levels above 3.0 μg/mL, but there was no clinical evidence of toxicity. Wound drain amounts (0.53-26.69 mg) indicate reinfusion should be safe, although further study is needed to confirm this.

Intraoperative wound infiltration with bupivacaine in patients undergoing lumbar spine surgery

We conducted a randomized double-blind trial to evaluate the effect of intraoperative wound infiltration with bupivacaine 0.25% (1 ml/kg) compared to placebo (NaCl 0.9% 1 ml/kg) in patients undergoing lumbar spine surgery. Fifty-two patients were entered in the trial and 50 completed it. Two methods of wound infiltration were assessed: (a) infiltration after partial wound closure and (b) infiltration prior to wound closure. Postoperatively patients received morphine sulfate on demand. Visual analog pain scores were recorded every 2 h for 12 h after the operation. Analgesia requirements were recorded over the duration of the study for each patient. The patients who received bupivacaine infiltration prior to wound closure had significantly reduced pain scores in the recovery room and used significantly less morphine in the first 2 h following the procedure. They also had reduced pain scores and reduced morphine demand in the first 10 h but this did not reach statistical significance. No difference was noted between the placebo group and those receiving infiltration after partial wound closure. It is concluded that infiltration of bupivacaine is a simple and safe aid in obtaining analgesia in patients undergoing lumbar spine surgery provided that it is infiltrated prior to wound closure.

Intraoperative Wound Infiltration With Bupivacaine in Patients Undergoing Elective Cholecystectomy

In a double-blind randomized trial, 50 patients scheduled for elective cholecystectomy received 50 mL of either 0.25% bupivacaine hydrochloride or physiologic saline by wound perfusion at the end of the operation before wound closure. The duration of incisional infiltration, total amount of postoperative analgesics administered, and total hospital stay were recorded. Pulmonary function tests were performed the day before surgery and 1 day after surgery. There was no difference between the two groups with regard to duration of analgesia, the amount of analgesics administered, or the total hospital stay. Both groups also had similar decrements in forced vital capacity and forced expiratory volume on the first postoperative day. We conclude that wound infiltration with 0.25% bupivacaine after elective cholecystectomy is not effective in reducing postoperative pain. Lung function disturbances cannot be prevented.