Wound Infiltration For Postoperative Analgesia Research Articles

Ultrasound-guided subcostal approach of transversus abdominis plane block compared with wound infiltration for postoperative analgesia following laparoscopic cholecystectomy: A systematic review and meta-analysis.

Despite laparoscopic cholecystectomy (LC) is a commonly performed operation under ambulatory setting, significant postoperative pain is still a major concern. The ultrasound-guided subcostal approach of transversus abdominis plane (sTAP) blocks and wound infiltration (WI) are both widely practiced techniques to reduce postoperative pain in patients undergoing LC. Although these methods have been shown to relieve postoperative pain effectively, the relative analgesic efficacy between ultrasound-guided sTAP blocks and WI is not well known. We searched PubMed, EMBASE, and CENTRAL to identify all randomized controlled trials (RCTs) comparing ultrasound-guided sTAP block versus WI for postoperative pain control in adult patients undergone LC. The search was performed until May 2023. Primary outcome was defined as 24-hour cumulative opioid consumption. Secondary outcomes were postoperative pain scores and the incidence of postoperative nausea and vomiting (PONV). Finally, 6 RCTs were included, and data from 314 participants were retrieved. Postoperative 24-hour opioid consumption was significantly lower in ultrasound-guided sTAP group than in the WI group with a mean difference of -6.67 (95% confidence interval: -9.39 to - 3.95). The ultrasound-guided sTAP group also showed significantly lower pain scores. Incidence of PONV did not significantly differ between the 2 groups. We conclude that there is low to moderate evidence to advocate that ultrasound-guided sTAP block has better analgesic effects than WI in patients undergoing LC. Further trials are needed with robust methodology and clearly defined outcomes.

Comparison of Bilateral Ultrasound-Guided Intermediate Cervical Plexus Block vs Local Wound Infiltration for Postoperative Analgesia in Patients Undergoing Total Thyroidectomy

Abstract Background The thyroid gland surgery is a common and painful procedure demanding analgesia. Bilateral intermediate cervical plexus block (BSCPB) could be beneficial for analgesia in thyroid surgery. In this study we will evaluate the analgesic efficacy of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia. Objective To evaluate the analgesic efficacy and possible side effects of ultrasound guided intermediate cervical plexus block vs local wound infiltration in patients undergoing elective thyroidectomy under general anaesthesia as a primary outcome. The secondary outcome is the assessment of the safety of ICPB and the total dose of meperidine used for 24 hours postoperatively. Patients and Methods 40 patients were divided into two equal groups: Group A: The patients received intermediate cervical plexus block with 10 ml of 0.25% bupivacaine. The same will be repeated on the contralateral side. Group B: Patient will receive local wound infiltration with 20 ml bupivacaine 0.25% under the skin immediately before extubation by the surgeon for pain control. Results ICPB group showed significant lower median score compared with LWI group at time 2 hrs, 4 hrs, 6 hrs, 12 hrs The time for first dose meperidine was significantly longer in ICPB group (17.2 ± 3.02 vs 10.15 ± 1.84) while Total 24 h meperidine consumption was significantly less in ICPB (26.25 ± 17.16 vs 36.25 ± 12.76) Conclusion Intermediate cervical plexus block provides another safe alternative analgesia compared to superficial blocks and local wound infiltration with better analgesic efficacy.

Ultrasound-guided quadratus lumborum block versus ilioinguinal-iliohypogastric nerve block with wound infiltration for postoperative analgesia in unilateral inguinal surgeries: A randomised controlled trial.

Ultrasound (US)-guided quadratus lumborum (QL) block is an abdominal field block that has high efficacy in providing postoperative analgesia for abdominal surgeries. This study was undertaken to compare the US-guided QL block with ilioinguinal-iliohypogastric (IIIH) nerve block and local wound infiltration in unilateral inguinal surgeries, in terms of analgesia and overall patient satisfaction. This randomised controlled trial was conducted in two groups of thirty each. After the completion of surgery under spinal anaesthesia, patients in Group QL received 20 ml of inj. ropivacaine 0.5% while patients in Group IL received 10 ml of inj. ropivacaine 0.5% at the ilioinguinal-iliohypogastric nerve site and 10 ml of inj. ropivacaine 0.5% that was locally infiltrated at the surgical site. Duration of analgesia, Visual Analogue Scale (VAS) score, total requirement of analgesic dosage in the first 24 hours, and patient satisfaction score were compared in both the groups. Statistical analysis was performed using unpaired student's t test and Chi-squared test with IBM SPSS Statistics version 21 software. Duration of analgesia was significantly higher in Group QL (544.83 ± 60.22 min) when compared with Group IL (350.67 ± 67.97 min; P < 0.0001). VAS scores and analgesic requirements were also lower in Group QL. The patient satisfaction score was significantly higher in Group QL (3.93 ± 0.91) when compared to Group IL (3.4 ± 1.0; P < 0.05). US-guided QL block significantly prolongs the duration and quality of postoperative analgesia, thereby reducing analgesic consumption and increasing overall patient satisfaction.

Bilateral ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in lumbar spinal fusion surgery: a randomized controlled trial

PurposeBoth erector spinae plane block and wound infiltration are used to improve analgesia following spinal fusion surgery. Herein, we compared the analgesic effect of bilateral erector spinae plane block with wound infiltration in this patient population.MethodsIn this randomized trial, 60 patients scheduled for elective open posterior lumbar interbody fusion surgery were randomized to receive either ultrasound-guided bilateral erector spinae plane block before incision (n = 30) or wound infiltration at the end of surgery (n = 30). Both groups received standardized general anesthesia and postoperative analgesia, including patient-controlled analgesia with sufentanil and no background infusion. Opioid consumption and pain intensity were assessed at 2, 6, 12, 24, and 48 h after surgery. The primary outcome was cumulative opioid consumption within 24 h after surgery.ResultsAll 60 patients were included in the intention-to-treat analysis. The equivalent dose of sufentanil consumption within 24 h was significantly lower in patients given erector spinae plane block (median 11 μg, interquartile range 5–16) than in those given wound infiltration (20 μg, 10 to 43; median difference − 10 μg, 95% CI − 18 to − 3, P = 0.007). The cumulative number of demanded PCA boluses was significantly lower with erector spinae plane block at 6 h (median difference − 2, 95% CI − 3 to 0, P = 0.006), 12 h (− 3, 95% CI − 6 to − 1, P = 0.002), and 24 h (− 5, 95% CI − 8 to − 2, P = 0.005) postoperatively. The proportion given rescue analgesia was also significantly lower in patients given erector spinae plane block group within 48 h (relative risk 0.27, 95% CI 0.07 to 0.96, P = 0.037). There were no statistical differences in pain intensity at any timepoints between groups. No procedure-related adverse events occurred.ConclusionsCompared with wound infiltration, bilateral ultrasound-guided erector spinae plane block decreases short-term opioid consumption while providing similar analgesia in patients following lumbar spinal fusion surgery.Chinese Clinical Trial Registry: ChiCTR2100053008.

Technology or tradition? Transversus abdominis plane block versus wound infiltration for postoperative analgesia after lower abdominal surgeries

Technology or tradition? Transversus abdominis plane block versus wound infiltration for postoperative analgesia after lower abdominal surgeries

Retraction: Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

[This retracts the article DOI: 10.7759/cureus.21311.].

Transversus Abdominis Plane Block Versus Local Anesthetic Wound Infiltration for Postoperative Analgesia in Adult Patients Undergoing Hernia Repair in Daycare Procedure: A Randomized Control Trial.

Introduction: Various modalities are now being used to manage postoperative pain, such as regional nerve blocks techniques, continuous epidural analgesia, patient-controlled analgesia, opioids, and systemic non-steroidal anti-inflammatory drugs. This study compared the mean postoperative pain score between ultrasound-guided transversus abdominis plane (TAP) block and a local anesthetic wound infiltration at the surgical incision site.Methodology: A prospective, comparative, randomized controlled trial (RCT) was carried out from February 2021 to September 2021. The study was conducted in the anesthesia department of Dow University of Health Sciences, Karachi, Pakistan. Patients aged 18-80 years presenting with elective surgery of (both direct and indirect) inguinal hernia repair were enrolled in the study. Participants were randomly assigned into one of the two groups that are local anesthetic wound infiltration (Group A) and TAP block (Group B). The mean pain score was assessed using a visual analog scale and compared between the two groups.Results: The study included 168 patients grouped in two different groups. The mean age in Group A was 43.87 (+17.21), and Group B was 47.01 (±15.37). Mean pain scores in groups A and B were 6.36±1.94 vs 4.51 ± 1.99 (p-value=0.001). The pain rescue medications were given to 57.14% of patients in Group A and 34.52% of patients in Group B, and it was significantly different in the two groups (p-value=0.003). It was found that patients in Group A reported more severe pain (41.67%) than patients in Group B (10.71%).Conclusion: When compared to local anesthetic wound infiltration, ultrasound-guided TAP block had better analgesic activity compared to local anesthetic wound infiltration.

A comparison of ultrasound guided bilateral single injection shot Erector Spinae Plane blocks versus wound infiltration for post-operative analgesia in laparoscopic assisted colonic surgery- a prospective randomised study

BackgroundBoth wound infiltration (WI) with local anaesthetic and Erector Spinae Plane block (ESPB) have been described for post-operative analgesia after abdominal surgery. This study compared the efficacy of WI versus ESPB for post-operative analgesia after laparoscopic assisted colonic surgery.MethodsSeventy-two patients between 18 and 85 years of age undergoing elective surgery were randomised to receive either WI or ESPB. In the WI group a 40 ml bolus of 0.5% Ropivacaine, infiltrated at the ports and minimally invasive wound at subcutaneous and fascia layers. In the ESPB group at T8 level, under ultrasound guidance, a 22-gauge nerve block needle was passed through the Erector Spinae muscle to reach its fascia. A dose up to 40 ml of 0.5% Ropivacaine, divided into two equal volumes, was injected at each side. Both groups had a multimodal analgesic regime, including regular Paracetamol, dexamethasone and patient-controlled analgesia (PCA) with Fentanyl. The primary end point was a post-operative pain score utilising a verbal Numerical Rating Score (NRS, 0–10) on rest and coughing in the post anaesthetic care unit (PACU) and in the first 24 h. Secondary outcomes measured were: opioid usage, length of stay and any clinical adverse events.ResultsThere was no significant treatment difference in PACU NRS at rest and coughing (p-values 0. 382 and 0.595respectively). Similarly, there were no significant differences in first 24 h NRS at rest and coughing (p-values 0.285 and 0.431 respectively). There was no significant difference in Fentanyl use in PACU or in the first 24 h (p- values 0.900 and 0.783 respectively). Neither was there a significant difference found in mean total Fentanyl use between ESPB and WI groups (p-value 0.787).ConclusionOur observations found both interventions had an overall similar efficacy.Trial registrationThe study was registered with the Australian New Zealand Clinical Trial Registry (ACTRN: 12619000113156).

Comparison of analgesic efficacy of transversus abdominis plane block with local wound infiltration using 0.25% levobupivacaine for post cesarean analgesia: A randomized controlled trial

The key component of Enhanced recovery after cesarian section (ERAC) is to improve maternal and child outcome and enhance recovery by dint of effective non opioid based pain control. We aim to compare the efficacy of Transverse abdominis plane (TAP) block with local wound infiltration for postoperative analgesia in cesarian section (CS).Eighty-two patients undergoing caesarean section under spinal anaesthesia were randomized to undergo local wound infiltration(Group I) (n=41) versus landmark guided bilateral TAP plane block (Group T) with 20ml of 0.25% levobupivacaine postoperatively Each patient was assessed post-operatively by a blinded investigator at regular intervals up to 24 h for visual analogue score (VAS). Requirement of analgesia, patient satisfaction, time for the first and second rescue analgesia, and the incidence of side effects was also noted. The median VAS was more in the group I compared to group II and was statistically significant (p=0.0032). The mean time to first rescue analgesia was prolonged in group I (4.060 ± 0.682 hrs) compared to group T (3.302 ± 0.519 hrs)(P&amp;#60; 0.001). The mean total analgesic requirement in 24 hours was reduced in group T (89.63 ± 41.82) as compared to group I (137.2 ± 33.13) (P&amp;#60;0.001. Group (T) compared to group I patient had a higher mean patient satisfaction score (1.487 ± 0.589) (2.097 ± 0.430) respectably (P &amp;#60; 0.001).TAP block provides better quality of analgesia and can be safely incorporated as a part of multi-model analgesic regimen postoperative pain over local infiltration in cesarian section.

Transversus abdominis plane block compared with wound infiltration for postoperative analgesia following Cesarean delivery: a systematic review and network meta-analysis

This systematic review and network meta-analysis (NMA) compared postoperative analgesic efficacy of transversus abdominis plane (TAP) blocks with that of wound infiltration for Cesarean delivery (CD) without long-acting neuraxial opioid administration. We sought randomized-controlled trials comparing TAP vs wound infiltration, and inactive control vs either TAP or wound infiltration. Wound infiltration included single-dose infiltration (WI), or continuous infusion via a catheter (WC). The primary outcome was 24 hr opioid consumption. Secondary outcomes included 12 and 24 hr pain scores (resting and movement), time to first analgesia request, incidence of postoperative nausea and vomiting (PONV), maternal sedation, and pruritus. We performed a NMA incorporating both direct and indirect comparisons and reported standardized mean differences and odds ratios with 95% confidence intervals for continuous and dichotomous outcomes. Forty-two studies were included, comprising 2,906 participants. Transversus abdominis plane blocks and WC were associated with significantly lower 24 hr opioid consumption than inactive controls, but there were no significant differences between WI and inactive controls. There was no statistically significant difference in 24 hr opioid consumption between TAP blocks and WC or WI techniques. The network ranking of treatments was TAP block, followed by WC or WI. No significant differences were shown between TAP, WC, and WI groups for 24 hr pain scores, time to first analgesia, PONV, sedation, and pruritus. Quality of evidence was moderate for most of the outcomes assessed. In the absence of long-acting neuraxial opioid after CD, single-dose TAP blocks and WC are effective opioid-sparing strategies.

Comparitive Study Between Ultrasound Guided Rectus Sheath Block versus Local Wound Infiltration for Post-Operative Analgesia in Patients Undergoing Midline Exploratory Surgeries

Abstract Background Poorly controlled acute pain after abdominal surgery is related to somatic pain signals derived from the abdominal wall and is associated with a variety of unwanted post-operative consequences, including patient suffering, distress. respiratory complications, delirium, myocardial ischemia, prolonged hospital stay, an increased likelihood of chronic pain, increased consumption of analgesics, delayed bowel function and increase the requirement for rescue analgesics. Appropriate pain treatment protocols to reduce postoperative morbidity, improve the results of the surgery and decrease hospital costs. Objective To assess the postoperative analgesic efficacy of Rectus Sheath Block (RSB) compared local wound infiltration after midline incision regarding the pain relief, effect on hemodynamics, requirement of first supplemental doses of analgesia and total number of doses received. Patients and Methods All patients were informed with the procedure US guided RSB block and were trained to use the visual analogue scale (VAS). The study was conducted on 50 randomly chosen patients aged 20 to 60 years, American Society of Anesthesiologists (ASA) class I or II scheduled for elective midline exploratory surgery. In Ain Shams University Hospitals after approval of the medical ethical committee. They were allocated in two groups of 25 patients each: RSB block Group: received general anaesthesia and 20 ml of 0.25% bupivacaine on each side under ultrasound guidance. Local wound infiltration: received general anaesthesia and with 0.25% bupivacaine 20 ml at surgical site. Results The results of the study revealed that there is Patients receiving RSB block had significantly lower pain scores at rest for 12 h and on mobilization for 6 h after operation and decrease total need of analgesic in first 24 h post-operative compared with patients who received wound infiltration of local aneasthetic. Conclusion U/S-guided rectus sheath block is as effective analgesic technique as local infiltration of the surgical wound, with longer duration of action and pethidine -sparing effect during the postoperative period after midline exploratory surgeries.

Comparison of ultrasoundguided ilioinguinal iliohypogastric nerve block with wound infiltration during pediatric herniotomy surgeries

Background and Aims:The purpose of this study was to compare the analgesic efficacy of the ilioinguinal-iliohypogastric nerve block (II/IH) with local wound infiltration in children undergoing herniotomy surgeries.Methods:After ethics committee approval and informed consent, 100 children aged 6 months–7 years posted for herniotomy surgeries were randomly divided into Group B and Group W. Local wound infiltration was performed in Group W by the surgeon at the time of port placement and the end of the surgery with 0.2 mL.kg−1 of 0.25% bupivacaine. Ipsilateral II/IH was performed in Group B at the end of the surgery, under ultrasonographic guidance with a Sonosite portable ultrasound unit and a linear 5–10 MHz probe with a 22G hypodermic needle, and 0.2 mL.kg−1 of 0.25% bupivacaine was used on each side. The parameters recorded were postoperative hemodynamics, paracetamol and opioid requirements, postoperative pain scores, postoperative nausea vomiting, and the need for rescue analgesia in the first 6 h postoperatively.Results:The median pain scores were significantly lower in the II/IH group than the local wound infiltration group at 10 min (2 [0–2.5] compared to 2 [3–4]; P = 0.011), 30 min (1.5 [0–3] compared to 3 [2–5]; P < 0.001), 1 h (1.5 [0–2] compared to 2 [2–3]; P < 0.001) and 2 h (2 [0–2] compared to 2 [1.5–2.5]; P = 0.010) postoperatively. The need for postoperative opioids and rescue analgesia was also significantly lower in the II/IH group (P < 0.001).Conclusion:II/IH is superior to local wound infiltration for postoperative analgesia in pediatric herniotomy surgeries.

Ultrasound-guided transversus abdominis plane block versus local anesthetic wound infiltration for postoperative analgesia after lower abdominal surgery

Ultrasound-guided transversus abdominis plane block versus local anesthetic wound infiltration for postoperative analgesia after lower abdominal surgery

Comparative study of clonidine and dexmedetomidine as adjuvants to bupivacaine in wound infiltration for postoperative analgesia after abdominal hysterectomy: A prospective randomized study

Comparative study of clonidine and dexmedetomidine as adjuvants to bupivacaine in wound infiltration for postoperative analgesia after abdominal hysterectomy: A prospective randomized study

Transversus Abdominis Plane Block versus Ilioinguinal/Iliohypogastric Nerve Block with Wound Infiltration for Postoperative Analgesia in Inguinal Hernia Surgery: A Randomized Clinical Trial.

Background:Various analgesic modalities have been used for postoperative analgesia in patients undergoing inguinal hernia surgery. In this randomized clinical trial, we have compared the analgesic efficacy of transversus abdominis plane (TAP) block with that of ilioinguinal/iliohypogastric (IIIH) nerve block with wound infiltration in patients undergoing unilateral open inguinal hernia repair.Aim:The primary objective of this study was to compare the efficacy of postoperative analgesia of ultrasound-guided TAP block and IIIH block with wound infiltration (WI) in patients undergoing open inguinal hernia surgery.Settings and Design:This was a randomized clinical trial performed in a tertiary care hospital.Materials and Methods:Sixty patients scheduled for hernia repair were randomized into two groups, Group T and Group I. Postoperatively, under ultrasound guidance, Group T received 20 ml of 0.25% ropivacaine – TAP block and Group I received 10 ml of 0.25% ropivacaine – IIIH block + WI with 10 ml of 0.25% ropivacaine. The primary outcome measure was the time to rescue analgesia in the first 24 h postoperatively. Fentanyl along with diclofenac was given as first rescue analgesic when the patient complained of pain.Statistical Analysis:Statistical comparisons were performed using Student's t-test and Chi-square test.Results:Mean time to rescue analgesia was 5.900 ± 1.881 h and 3.766 ± 1.754 h (P < 0.001) and the mean pain scores were 5.73 ± 0.784 and 6.03 ± 0.850 for Group TAP and IIIH + WI, respectively. Hemodynamics were stable in both the groups. One-third of the patients received one dose of paracetamol in addition to the rescue analgesic in the first 24 h. There were no complications attributed to the block.Conclusion:As a multimodal analgesic regimen, definitely both TAP block and IIIH block with wound infiltration have a supporting role in providing analgesia in the postoperative period for adult inguinal hernia repair. In this study, ultrasound-guided TAP block provided longer pain control postoperatively than IIIH block with WI after inguinal hernia repair. There were no complications attributed to the blocks in either of the group.

Intravenous esmolol versus ropivacaine abdominal wound infiltration for postoperative analgesia after inguinal herniotomy: a randomized controlled trial

Objectives This study was designed as a randomized comparison of postoperative pain after inguinal herniotomy in patients treated with intravenous esmolol and others treated with ropivacaine abdominal wound infiltration. Patients and methods Sixty American Society of Anesthesiologists physical status I-II patients undergoing herniotomy and anesthetized with isoflurane were randomized into one of two groups. Group R received 20 ml of ropivacaine 0.75% in 20 ml of saline 0.9% preincisional wound infiltration and group E patients received a bolus of esmolol 0.5 mg/kg intravenous at induction followed by an infusion of 5-15 mg/kg/min. After surgery, a bolus of pethidine was given according to visual analogue scale for pain intensity. Results Patients in group E had lower pain scores than patients in group R. Median consumption of pethidine was higher in group R than in group E. Conclusion Intravenous esmolol reduces pethidine consumption and provides more analgesia compared with preincisional ropivacaine infiltration in patients undergoing herniotomy.

377: Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

377: Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

377. Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

377. Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

Comparison of Intercostal Nerve Block With Wound Infiltration for Postoperative Analgesia in Patients Undergoing Appendicectomy

Comparison of the effectiveness of bilateral ilioinguinal nerve block and wound infiltration for postoperative analgesia after Caesarean section

We have studied the effects of bilateral ilioinguinal nerve block and wound infiltration with 0.5% bupivacaine on postoperative pain and analgesic requirements in 62 patients undergoing Caesarean section under general anaesthesia. A control group received no local anaesthetic supplementation. Both ilioinguinal block and wound infiltration reduced significantly the pain scores and analgesic requirements in the immediate postoperative period (P < 0.05). The differences in pain scores and analgesic requirements between the study groups were not statistically significant (P > 0.05).