Preemptive Local Infiltration Research Articles

The Effect of Preemptive Local Infiltration on Postoperative Pain After Vaginal Hysterectomy: A Retrospective Study

To investigate the effect of preemptive infiltration on postoperative pain and the use of analgesics after vaginal hysterectomy (VH). A retrospective study. An urogynecology unit in a tertiary medical center. A total of 120 patients who had undergone VH. The study group contained 60 patients who participated in a former randomized control study, in which preemptive local infiltration of bupivacaine (n=30) or sodium chloride 0.9% (n=30) was performed. The control group included 60 consecutive patients who underwent a VH, for whom no local infiltration was performed. Postoperative pain at rest was assessed using the 10 cm visual analog scale at 3, 8, and 24 hours after surgery. The levels of pain, as well as the use of analgesics, postoperatively, were compared between the groups. The mean surgery length in the infiltration group was shorter (86.4±29 vs 118.6±30, p <.001) and the rate of posterior colporrhaphy was lower (73.1% vs 91.3%, p=.010) than the control group. There were no differences in levels of pain at all points of time. However, the infiltration group required a lower morphine dose in the recovery unit (3.7 ± 2.3 mg vs 5.3 ± 2.4 mg, p <.001) and less use of analgesia (all kinds) 24 hours after surgery (54.2% vs 79.6%, p <.001) compared with the control group. On multivariant analysis, preemptive infiltration was found to be independently inversely associated with the dose of morphine used in recovery, as well as analgesics used 24 hours after surgery. Preemptive local infiltration of either bupivacaine or sodium chloride 0.9% reduced the use of morphine in the recovery unit, as well as the use of analgesics 24 hours after VH, compared with no infiltration at all.

Preemptive Infiltration with Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy (PRE-EASE): study protocol for a randomized controlled trial

BackgroundLaminoplasty and laminectomy have been used for decades for the treatment of intraspinal space-occupying lesions, spinal stenosis, disc herniation, injuries, etc. After these procedures, patients often experience severe postoperative pain at the surgical site. Intense immediate postoperative pain after many spinal procedures makes its control of utmost importance. Preemptive injection of local anesthetics can significantly reduce postoperative pain during rest and movement; however, the analgesic effect is only maintained for a relatively short period of time. Whether betamethasone combined with local anesthetic for laminoplasty or laminectomy has better short-term and long-term effects than the local anesthetic alone has not been reported yet.MethodsThe PRE-EASE trial is a prospective, randomized, open-label, blinded endpoint, single-center clinical study including 116 participants scheduled for elective laminoplasty or laminectomy, with a 6 months’ follow-up process. Preemptive local infiltration with betamethasone and ropivacaine (treatment group) or ropivacaine alone (control group) throughout the entire thickness of the planned incision site will be performed by the surgeon prior to making the incision. The primary outcome will be the cumulative butorphanol consumption within the first 48-h postoperative period.DiscussionThis study will add significant new knowledge to the effect and feasibility of preemptive local infiltration of betamethasone for postoperative pain management in laminoplasty and laminectomy.Trial registrationClinicalTrials.gov: NCT04153396. Registered on 6 November 2019.

Preemptive Local Infiltration of 0.5% Levobupivacaine HCl vs 0.5% Ropivacaine HCl for Postoperative Pain Control in Lumbar Laminectomy Patients

Preemptive Local Infiltration of 0.5% Levobupivacaine HCl vs 0.5% Ropivacaine HCl for Postoperative Pain Control in Lumbar Laminectomy Patients

Post Spinal Surgery Pain: Management Begins Before Your Approach

Background Data: Patients scheduled for spinal surgeries are expected to experience severe postoperative pain. Thus, effective postoperative analgesia is necessary to obtain an enhanced functional outcome, early ambulation, short hospital stay and prevention of chronic pain. Although opioid is the key element of most postoperative analgesic regimens, multimodal therapy is currently an effective way to decrease opioid usage and the related adverse events. Pre-incision infiltration with local anesthetic is used to improve postoperative analgesia and reduce opioid consumption when given as a part of multimodal analgesia. Purpose: The purpose of this study was to prospectively evaluate the effectiveness of preemptive local infiltration with local anesthesia combined with systemic analgesia in pain control after spine surgery.Study Design: A prospective descriptive clinical case study. Patients and Methods: A prospective study of 147 cases of spine surgery operated at the neurosurgery department in Sohag university hospital from December 2011 to March 2015 was conducted. A basic monitoring was applied to all patients and anesthesia was induced according to the standardprotocol following preemptive local infiltration with local anesthesia. Postoperative pain was controlled with paracetamol, ketorolac and/or nalbuphine. Postoperative pain was assessed using visual analogue score (VAS).Results: The study included 66 females and 81 male patients, aged 19-77 years. Discectomy was rated in spine surgeries followed by lumbar fixation, laminectomy, spinal cord tumors, lateral mass fixation and discectomy with cage. VAS didn’t exceed score 3 except for 9 cases rating (6%). They requested rescue analgesia. Most of the patients were allowed to move 3 hours after surgery except for those who revealed intraoperative dural injury (11 cases). Almost all patients were discharged to home after a short hospital stay less than 3 days. Only 9 cases stayed >3 days. Conclusion: Preemptive local infiltration with local anesthesia combined with systemic analgesia allowed good pain control after spine surgery, early ambulation, shortened the time of hospital stay and decreased the incidence of complications. (2015ESJ098)

Pre-emptive peritonsillar dexamethasone vs. levobupivacaine infiltration for relief of post-adenotonsillectomy pain in children: A controlled clinical study

ObjectivesTo investigate the effects of the pre-emptive local infiltration of dexamethasone vs. levobupivacaine on postoperative pain and morbidity in pediatric adenotonsillectomy patients. MethodsA total of 60 patients (32 males and 28 females), aged 3–14 years, were included in this double-blind prospective randomized controlled clinical study from September of 2011 until May of 2012. Patients admitted for adenotonsillectomies after informed consent was obtained from the parents, and randomized into three groups receiving either dexamethasone sodium phosphate (Group 1, mean age 5.9±1.6), levobupivacaine with epinephrine (Group 2, mean age 6.1±2.6), or saline (Group 3, mean age 6.0±3.4). Pain scores at the 1st, 4th, 8th, 12th, 16th, and 20th hours, and first, second, third and seventh days post-operatively were recorded by the parents using McGrath’s face scale. The operation type, operation time and anesthesia time, the time of the first request for postoperative analgesia, and the total number of analgesic interventions were recorded. ResultsPain scores were revealed in this order: Group 1 (steroid)<Group 2 (levobupivacaine)<Group 3 (saline) at all times (p=0.000). The anesthesia times for Group 1 and Group 2 were different (steroid vs. levobupivacaine), and the time to first analgesic was longer in Groups 1 (steroid) and 2 (levobupivacaine) than in Group 3 (saline) (p<0.000). The total number of analgesic interventions was lower in Group 1 (steroid) than in Group 2 (levobupivacaine) and Group 3 (saline) (steroid vs. saline, p=0.000, and steroid vs. levobupivacaine, p<0.05). ConclusionPeritonsillar dexamethasone infiltration was more effective than both levobupivacaine and saline in reducing post-tonsillectomy pain. It was proven to be a safe and effective method.

The effects of dexamethasone and levobupivacaine on postoperative pain in Modified Radiofrequency Assisted Uvulopalatoplasty (MRAUP) surgery

The objective of this prospective, randomized study was to evaluate the effect of pre-emptive local infiltration of lidocaine, lidocaine plus dexamethasone, levobupivacaine and levobupivacaine plus dexamethasone on postoperative pain in Modified Radiofrequency Assisted Uvulopalatoplasty (MRAUP) cases. Sixty adult patients (44 males and 16 females) aged 32-51years with simple snoring were divided into four groups. The anesthesia of the patients in the first group was achieved with lidocaine HCl, in the second group, with lidocaine HCl and dexamethasone sodium phosphate, in the third group, with levobupivacaine, and in the fourth group, levobupivacaine and dexamethasone sodium phosphate. All the patients were applied Modified Radiofrequency Assisted Uvulopalatoplasty technique. The pain experienced by the patients during swallowing and at rest on the 1st, 3rd, 5th, 7th, and 10thday and analgesic consumption were evaluated using standard 10cm visual analog scales. The mean duration of operation in the group that received lidocaine HCl was 22±3min, while in the group that received levobupivacaine HCl was 27±4min. There were statistically significant differences between the groups for analgesic effects on the 1st, 3rd, 5th, and 7thday and for the amount of analgesics used, on the 1st, 3rd, and 5thday. The best results were obtained in the group that received levobupivacaine HCl and steroid (p<0.001). Steroid and local anesthetic combinations are superior to controls in the management of postoperative pain in MRAUP surgery.

Comparison of pre-emptive tonsillar lodge infiltration with ropivacaine versus intravenous tramadol in pediatric tonsillectomies: A randomized placebo-controlled study

ObjectiveTo investigate the placebo controlled effect of pre-emptive local infiltration of ropivacaine and intravenous tramadol in postoperative pain and nausea-vomiting in pediatric tonsillectomy cases. Methods90 children at ASA I-II physical status, who are between 2 and 9 years old, underwent tonsillectomy were included to the study. Patients were randomized into one of three study groups. Group I was i.v. saline group (placebo group), Group II was preemptive 1.5ml 0.75% ropivakain to the tonsil lodge and Group III was preemptive 1mg/kg i.v. tramadol. Hemodynamic parameters and synchronized Maunuksela pain scores were evaluated in the post anesthetic care unit. ResultsThere was no difference in age, weight, sex and hemodynamic parameters of children included to the study groups. Postoperative nausea vomiting was significantly lower in Group II and pain scores at resting and swallowing are significantly lower than the other study groups. Maunuksela pain scores at 2nd, 3rd, 6th and 9th hours while resting were significantly lower in Group II compared with Groups I and III (p<0.001). The comparison of scores between groups I and III were similar. Maunuksela pain scores during swallowing were significantly lower in Group II compared with Group I and III at 2nd, 3rd, 6th, 9th, 12th, 21st and 24th hours postoperatively (p<0.001). While comparing Maunuksela pain scores of Groups I and III, significantly lower scores are determined at 2nd and 24th hours in Group III (p<0.001). Analgesic needs were significantly low in Group II at postoperative period (150±30mg paracetamol) (p<0.05). It was similar in Groups I and III (Group I: 400±40mg, Group III: 360±40mg paracetamol). ConclusionThis study showed that peritonsillar ropivacaine infiltration might produce an effective postoperative analgesia probably due to a preventing effect on sensitization of the pain pathways.

Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

This prospective clinical study was carried out in the dept. of Anaesthesia, Analgesia and Intensive Care Medicine, BSMMU. Dhaka during the period of January 04 to September 04. The study was done to emphasize the importance of giving analgesics preemptively instead of waiting for the child to complain or express their pain and to improve post operative recovery status and associated response by reducing the immediate post operative pain with simple local anaesthetic infiltration. The children scheduled for elective herniotomy operation through a hernial incision under general anaesthesia were recruited in this study. Immediate recovery status in children was compared with preemptive (group-1 and without preemptive (group-II) local infiltration of 0.25% bupivacaine in herniotomy operation. No. of patients was 20 in each group. Pulse, systolic, diastolic and mean pressure, oxygen saturation, pain (scored by TPPPS), anaesthetic recovery (scored by steward recovery system) and mental status if the children were observed postoperatively at different time interval up to one hour. Pulse, systolic, diastolic, mean pressure were stable in group-1 then group-II. Oxygen saturation in both the groups were in clinically acceptable range but in group-11 5 mins after extubation fall more than that of group- l and statistically significant. Pain score (TPPPS) in group-1 was lower all the time period but in group-II the score was high, all the children required rescue pethidine within 10 mins after extubation, mean dose reqd, in group-II was 23.6+3.6mg. Steward recovery score in both group was not significant at early period but after 10 mins. P value become significant The mental state of group-I was calm &amp; quite only 3 were excited, on the other hand in group-11 all children were excited &amp; irritable and required rescue pethidine. So preemptive local infiltration of 0.25 bupivacaine improved the recovery status in children by reducing the immediate postoperative pain and there by decrease in postoperative morbidity. Journal of BSA, Vol. 18, No. 1 &amp; 2, 2005 p.38-44

Preemptive Ropivacaine Local Anaesthetic Infiltration Versus Postoperative Ropivacaine Wound Infiltration in Mastectomy: Postoperative Pain and Drain Outputs

The aim of this study was to investigate if preemptive local infiltration (PLA) with ropivacaine could improve postoperative pain and determine its effect on drain output postmastectomy with axillary dissection. This was a prospective, randomized trial comprising 30 women allocated to two groups: one to receive postoperative wound infiltration (POW) of 20 mL of 0.2% (40 mg) ropivacaine (Naropin) versus PLA with 20 mL of 0.2% ropivacaine (Naropin) diluted with 80 mL of 0.9% saline, total volume 100 mL. A visual analogue scale (0-100 mm) and angle of shoulder abduction were used for evaluation of pain. Postoperatively, all patients received oral ibuprofen 400 mg tds. There was no significant difference in postoperative pain for the first 3 days between the two groups. There were wider shoulder abduction angles in the 1st and 3rd postoperative days in the PLA group, but this was not significant. Operative time was significantly shorter in the PLA group than in the POW group (69.34+/-59.37 minutes vs. 109.67+/-26.96 minutes; p=0.02). The axillary drain was removed earlier in the preemptive group, 5.4+/-1.55 days versus 6.8+/-2.04 days in the postoperative group (p=0.04). We found no difference in postoperative pain between preemptive tumescent ropivacaine infiltration and postoperative ropivacaine wound infiltration.

The Effect of Preemptive Local Infiltration of Lidocaine and Gabapentin on Postoperative Pain in Rats

Background: Preemptive analgesia may improve postoperative antinociceptive treatment that prevents the development of central sensitization which contributes to post-injury pain hypersensitivity. However, beneficial effects of preemptive analgesia appear controversial. The purpose of this study was to examine the effect of preand post-incisional local infiltration of lidocaine and gabapentin on incisional pain in rats. Methods: Thirty five male rats were divided into 7 groups; control group (n = 5), pre-lidocaine infiltration group (n = 5), post-lidocaine infiltration group (n = 5), pre-gabapentin 10 mg infiltration group (n = 5), post-gabapentin 10 mg infiltration group (n = 5), pre-gabapentin 30 mg infiltration group (n = 5), and post-gabapentin 30 mg infiltration group (n = 5). To evaluate postoperative mechanical hyperalgesia in injured feet, withdrawal thresholds were measured by calibrated von Frey filaments at 2 hrs, 1, 2, 3, 4, and 5 days after an incision. Results: The pre-lidocaine infiltration group shows better analgesic effects than post-lidocaine infiltration group until postoperative day 1 (P < 0.05). The gabapentin infiltration groups were effective in postoperative pain management but there were no significant differences between preand postincisional treatment. Conclusions: A preemptive lidocaine injection has a good analgesic effect on incisional pain. Gabapentin also has a good analgesic effect on incisional pain. (Korean J Anesthesiol 2001; 40: 389∼396) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ