Wound Infiltration Research Articles

INTRAOPERATIVE LOCAL BUPIVACAINE WOUND INFILTRATION VERSUS TRADITIONAL SYSTEMATIC ANALGESIA: A COMPARISON IN TERM OF POST-OPERATIVE PAIN

Effective management of post-operative pain is essential for patient recovery and satisfaction, especially in procedures like appendectomies where pain management can influence overall outcomes. Traditional systemic analgesia, while effective, often comes with side effects and limitations. Local infiltration of anesthetics like bupivacaine may provide a targeted approach to pain control with fewer systemic effects. Objective: To compare the effectiveness of intraoperative local bupivacaine wound infiltration versus traditional systemic analgesia in managing post-operative pain in patients undergoing appendectomies. Methods: This randomized controlled trial was conducted at Lady Reading Hospital, Peshawar, following approval from the hospital's Ethical Committee. A total of 60 patients, who consented and met eligibility criteria, were enrolled. All patients underwent appendectomy under general anesthesia, followed by random allocation into two groups. Group A received 0.5% bupivacaine for local wound infiltration, while Group B did not. Both groups were administered intravenous tramadol on demand, with a maximum dose of 400 mg per 24 hours. Post-operative pain was assessed using a Visual Analog Scale (VAS) at 4, 12, and 24 hours post-surgery. Stratified analysis by age and gender was also performed. Results: The study population (mean age: 41.13 ± 7.96 years) included 34 males (56.7%) and 26 females (43.3%). Group A (bupivacaine group) had a significantly lower mean post-operative pain score (3.33 ± 0.66) compared to Group B (systemic analgesia group) with a score of 5.30 ± 0.95 (p=0.00). Age-based stratification revealed significant differences: among 22-30-year-olds, Group A scored 3.00 versus 6.00 in Group B (p=0.00); for 31-50-year-olds, Group A scored 3.36 compared to 5.33 in Group B (p=0.00); and for those over 50, scores were 3.33 in Group A and 4.50 in Group B (p=0.04). Both male and female patients in Group A experienced significantly lower pain scores compared to Group B (p=0.00 for both). Conclusion: Intraoperative bupivacaine wound infiltration significantly reduces post-operative pain in appendectomy patients compared to traditional systemic analgesia. These findings support its use as an effective pain control method. Further research is recommended to optimize dosing and assess the combined use with other analgesics to enhance pain management across various surgical procedures.

Evidence-based Cesarean Delivery: Intraoperative management following placental delivery until skin closure (Part 9): Evidence based care during cesarean delivery.

This expert review provides recommendations for the cesarean technique after placental delivery to skin closure. Following placental delivery during cesarean, sponge curettage may be omitted as it has not been shown to decrease the risk of retained products of conception. Uterine irrigation and mechanical cervical dilation cannot be recommended. Either intra-abdominal or extra-abdominal repair of the hysterotomy is acceptable with some possible benefits with decreased postoperative pain and nausea/vomiting with intra-abdominal repair. There is insufficient evidence to recommend one uterine closure technique over the other with regards to suture type, continuous versus interrupted, locking or non-locking, one versus two-layer closure. Double layer uterine closure has been shown to be more beneficial with regards to residual myometrial thickness and full thickness bites (including endometrium) should be considered. Glove change by the surgical team is recommended after placental delivery and prior to closure of the abdominal wall. The following techniques are not recommended: intra-abdominal irrigation, use of adhesion-prevention barriers, peritoneal closure, and rectus muscle re-approximation. Based on non-cesarean evidence, fascial closure bites should be at least 5 × 5 mm with monofilament suture for vertical incisions. As an adjunct to postoperative pain control, surgeons may consider wound infiltration with local anesthesia either supra- or sub-fascial. Prior to closure, subcutaneous irrigation may be performed with saline, and routine use of subcutaneous drains is not recommended. Though closure of the subcutaneous layer can be considered in all patients, it should occur when the depth is ≥ 2cm. A monofilament absorbable suture, such as poliglecaprone, should be used to close the CD skin incision. There is no level 1 evidence evaluating the potential benefit of additional skin adhesive or sterile strips after suture skin closure. If a dressing is preferred over the skin incision the following may be considered: a DACC-impregnated dressing if available, otherwise a standard gauze dressing is appropriate. Prophylactic negative pressure would therapy can be considered in patients with obesity. Vaginal seeding at CD is not recommended.

BN SO57 - Transversus Abdominis Plane (TAP) Block in Laparoscopic and Robot-Assisted Cholecystectomy: Is it worth the effort?

Abstract Background Minimal access cholecystectomy is a common procedure undertaken worldwide. These are usually performed on an ambulatory basis and given the short timeline, strategies to optimize pain control and reduce nausea or vomiting are key factors to facilitate early hospital discharge. There has been studies showing that both TAP block and wound infiltration deliver superior pain relief after laparoscopic cholecystectomy, but TAP blocks are not used routinely after cholecystectomy in the U.K. This study aims to assess the efficacy of post-operative subcostal TAP block in laparoscopic and robot-assisted cholecystectomy in reducing post-operative opioid requirements and facilitating same day discharge. Method A retrospective cohort analysis was performed at a single centre (January 2022 – July 2023). Patients undergoing laparoscopic or robot assisted cholecystectomy under a single surgeon who performs cholecystectomy with additional use of postoperative TAP block were included. The primary outcome of post-operative opioid requirements was assessed. Secondary outcomes included length of post-operative stay and individual morphine/fentanyl requirements. Results Among 87 patients, 22(25.3%) underwent TAP block and 65(74.7%) had local anaesthetic infiltration of the port sites. Of the two cohorts, there were no significant differences in the age, M:F ratio or ASA grade. There were more obese patients (BMI > 30kg/m2) in the TAP block cohort (63.6% vs 47.7%; p= 0.012). Of the patients in the TAP block, 88.2% were discharged the same day. 95.5% of these patients had no post-operative morphine or fentanyl requirements.The difference in outcomes were not statistically significant. There were no post-procedural complications from use of the TAP block in any patient. Conclusion These results demonstrate that use of TAP block can provide a safe alternative approach for post-operative analgesia, with low post-operative opioid requirements and facilitation of same-day discharge.

Analgesic Efficacy of Transversus Abdominis Plane block vs Local Infiltration of Lignocaine and Bupivacaine in Post-operative Patients

Objective: To compare the effectiveness of Transversus Abdominis Plane (TAP) block vs Local Infiltration for pain management techniques in patients undergoing laparoscopic lower abdominal surgeries. Methodology: This cross-sectional study was conducted at the Department of Surgery, Lahore General Hospital, from March to May, 2024. It involved a total of 110 patients, divided into two groups of 55 each, between the ages of 20 to 60 years, diagnosed with indirect inguinal hernia by ultrasound. Chronic smokers, drug addicts, intravenous drug abusers, patients with a history of previous surgeries, with known drug allergies and with complicated hernia were excluded from this cross-sectional study. The Numerical Rating Scale (NRS) was used to see the pain variation and effectiveness of both techniques at 6, 12, 18 and 24 hours. Results: The mean age in the TAP Block Group was 32.0 ± 9.92 years, and the mean age in the Local Wound Infiltration Group was 34.21 ± 10.01 years. There were 108 (98.18%) male and 2(1.81%) female cases with a higher male-to-female ratio. The results indicated that the TAP Block group consistently required fewer rescue analgesic doses than the local wound Infiltration group at all postoperative time points. At 6 hours, 23.63% of patients in the TAP Block group needed additional analgesia, compared to 38.18% in the Wound Infiltration group, though this difference was not statistically significant. However, at 12, 18, and 24 hours, the TAP Block group showed a significantly lower need for rescue analgesia, with p-values of 0.002, and 0.008, respectively. Conclusion: In managing postoperative pain of Inguinal Hernia Repair, TAP Block is superior to Wound Infiltration of local anesthetic agent. After TAP Block NRS remains fewer and a smaller number of rescue doses are needed as compared to Wound infiltration.

Effects of paravertebral block on postoperative analgesia in children undergoing unilateral thoracotomy cardiac surgery with cardiopulmonary bypass: protocol for a randomised controlled trial

IntroductionThis study aims to determine whether paravertebral block (PVB) provides better postoperative analgesia, lower incidence of complications and faster recovery compared with local anaesthetic wound infiltration for school-aged children undergoing...

Effectiveness of ultrasound-guided ilioinguinal and iliohypogastric nerve block in pediatric inguinal hernia surgery: a systematic review and meta-analysis of randomized controlled trials

Aim: To evaluate the efficacy of ultrasound-guided ilioinguinal and iliohypogastric nerve block (IIHB) in children undergoing surgery for inguinal hernias.Material and methods: PubMed, Embase, Cochrane Library, and Web of Science databases were searched to January 4, 2024. For continuous data, the effect sizes were presented as weighted mean differences (WMDs), and for categorical data, they were reported as relative ratios (RR), each accompanied by 95% confidence intervals (CIs).Results: IIHB demonstrated a longer duration before the need for the first analgesic compared to transverse abdominis plane (TAP), caudal epidural block (CEB), and pre-incisional wound infiltration (PWI), but a shorter duration than quadratus lumborum block (QLB). The IIHB group had a higher probability of requiring rescue analgesics compared to other blocks or PWI (RR: 1.69, 95% CI: 1.25 to 2.28, p=0.001). Higher FLACC scores were noted at 12 hours for the IIHB group (WMD:0.50, 95% CI: 0.13 to 0.86, p=0.008). IIHB required more intraoperative fentanyl compared to controls (RR: 2.14, 95% CI:1.17 to 3.92, p=0.014).Conclusion: While IIHB may have some benefits, it does not appear to be more effective overall in managing postoperative pain in pediatric inguinal hernia surgery patients compared to other blocks or PWI.

Regional analgesia techniques following nephrectomy: a systematic review and network meta-analysis.

This network meta-analysis (NMA) was performed to assess the relative efficacy and safety of various regional analgesic techniques used in patients undergoing partial nephrectomy or nephrectomy. Randomized controlled trials (RCTs) evaluating different regional analgesia techniques in patients underwent partial nephrectomy or nephrectomy were retrieved from databases, including PubMed, Embase, Web of Science, and the Cochrane Library, from inception to January 2024. The NMA was made by using Stata 15.1 softwares. The certainty of evidence was assessed by using CINeMA. We included 27 trials with 1852 patients and 14 techniques. Postoperative resting pain scores within 24 hours were decreased by erector spinae plane block (ESPB), thoracic paravertebral block (TPVB), intrathecal morphine (IM), retrolaminar block (RLB). Postoperative movement pain scores within 24 hours were decreased by ESPB, TPVB, lateral quadratus lumborum block (QLB-L), transversus abdominis plane block. Postoperative opiates consumption within 24 hours were decreased most by QLB-L, followed by transmuscular QLB (QLB-TM), TPVB, and IM. Postoperative nausea and vomiting (PONV) were decreased by RLB, anterior QLB approach at the lateral supra-arcuate ligament (QLB-LSAL). Length of hospital stay were decreased by TPVB, ESPB. This available evidence suggests that ESPB and TPVB are more likely to reduce pain scores within 24 hours and shorten the length of hospital stay. QLB-L and QLB-TM are more likely to reduce the cumulative opiates consumption within 24 hours. RLB and QLB-LSAL are more likely to decrease the incidence of PONV. The wound infiltration (WI), intraperitoneal instillation (IPI), and WI+IPI are less likely to be effective.

A randomized controlled trial of wound infiltration with liposomal bupivacaine with or without intrathecal analgesia in patients undergoing laparotomy for advanced gynecologic malignancy

A randomized controlled trial of wound infiltration with liposomal bupivacaine with or without intrathecal analgesia in patients undergoing laparotomy for advanced gynecologic malignancy

Comparison of ilioinguial/iliohyphogastic nerves block with woundinfiltration on postoperative pain: A randomised controlled trial.

To compare postoperative pain scores at rest and on movement in patients undergoing open inguinal hernia repair between those receiving illioinguinal/illiohypogastric nerve block with ropivacaine or wound infiltration with ropivacaine. The randomised clinical trial was conducted at the Department of Anaesthesiology, Aga Khan University Hospital a tertiary care centre from March to August 2019 and comprised patients of either gender scheduled for elective unilateral open inguinal hernia repair under general anaesthesia. They were randomised into illioinguinal/illiohypogastric nerve block group A, and wound infiltration group B. In group A, 20 ml of 0.25% ropivacaine was infiltrated in the vicinity of the nerves under ultrasound guidance, while group B received wound infiltration with ropivacaine 10ml 0.25% at the end of surgery. Postoperative static and dynamic pain was assessed at 0, 2, 6, 12 and 24 hours using visual analogue scale. Total usage of opioids in 24 hours postoperatively in both groups, patient satisfaction and complications were recorded. Data was analysed using SPSS 19. Of the 60 patients, 30(50%) were in each of the 2 groups. There were 29(96.7%) males and 1(3.3%) female in group A with mean age 45.63±17.43 years, and 28(93.3%) males and 2(6.7%) females in group B with mean age 49.33±15.39. The mean pain score at rest was not significantly different between the groups (p>0.05). On movement, the mean pain score between the groups was different only at 6 hours (p=0.02). There were no significant intergroup difference in total usage of opioids in 24 hours postoperatively and patient satisfaction (p>0.05). Illioinguinal/illiohypogastric nerve block and wound infiltration with ropivacaine were found to be equally effective methods in controlling postoperative pain. NCT04462510.

Comparative efficacy of ultrasound-guided erector spinae plane block versus wound infiltration for postoperative analgesia in instrumented lumbar spinal surgeries

ObjectiveThis study compared the efficacy of ultrasound-guided erector spinae plane block (ESPB) and wound infiltration (WI) for postoperative analgesia in patients who underwent lumbar spinal surgery with instrumentation.MethodsIn this randomized controlled trial, 80 patients were divided into two groups: ESPB (n = 40) and WI (n = 40). Postoperative pain intensity was assessed via the visual analog scale (VAS) at multiple time points within 24 h. Additionally, opioid consumption, time to first rescue analgesia, incidence of postoperative nausea and vomiting (PONV), and patient satisfaction were evaluated.ResultsBoth ESPB and WI provided effective postoperative pain management, with no significant differences in VAS scores. However, the ESPB group demonstrated a significantly longer duration of analgesia, a shorter time to first rescue analgesia, and lower total tramadol consumption (50 ± 60 mg vs. 100 ± 75 mg; p = 0.010) than did the WI group. Furthermore, a trend toward reduced PONV incidence was observed in the ESPB group, likely due to its opioid-sparing effect.ConclusionWhile both ESPB and WI provided effective postoperative pain management, ESPB demonstrated a distinct advantage by offering a longer duration of analgesia and significantly reducing opioid consumption. These findings suggest that ESPB is more effective than WI for postoperative analgesia in lumbar spinal surgeries, providing prolonged pain relief and improving patient outcomes. Further studies are warranted to explore its long-term benefits and cost-effectiveness.Trial RegistrationClinicalTrials.govPRS: NCT06567964 Date: 08/21/2024 Retrospectively registered.

A comparative study to access the impact of TAP block with wound infiltration in laparoscopic cholecystectomy

Background: The transversus abdominis plane (TAP) block and local anesthetic wound infiltration have been used to relieve pain after laparoscopic cholecystectomy. This study investigated whether the subcostal transversus abdominis block was superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Aim and Objectives: To investigated whether the subcostal transversus abdominis block is superior to traditional port-site infiltration of local anesthetic in reducing post-operative pain, opioid consumption, and time for recovery. Materials and Methods: All patients were randomly assigned to two equal groups (n=30) using computer-generated randomization. Patients in Group 1 (TAP group) received a TAP block by administration of 10 mL of 0.5% bupivacaine on each side just before completion of surgery, and patients in Group 2 (local wound infiltration [LWI] group) received 10 mL of 0.5% bupivacaine as a local infiltrate at the local site just before completion of surgery. The pain was measured using a Visual Analog Scale (VAS) at intervals of 30 min to 24 h after the procedure. Results: The mean VAS score was significantly lower in group 1 as compared to group 2 at 2 h and 4 h. Whereas the VAS score was not significantly different post-operative 30 min, 6 h, 12 h, and 24 h. The mean first rescue analgesia was significantly more in Group 1 than in Group 2 (P<0.001). Conclusion: The TAP block patients had significant VAS scores at 2 and 4 h postoperatively compared to the LWI patients. The TAP group had a significantly longer median time to first emergency analgesia compared to the LWI group, with a higher proportion of patients requiring only one dose of emergency analgesia.

RETRACTION: Effect of wound infiltration of dexmedetomidine in lumbar spine surgery on postoperative wound pain: A meta-analysis.

Retraction: X. Wang, Y. Peng, Y. Si, and X. Hu, "Effect of Wound Infiltration of Dexmedetomidine in Lumbar Spine Surgery on Postoperative Wound Pain: A Meta-Analysis," International Wound Journal 21, no. 3 (2024): e14523, https://doi.org/10.1111/iwj.14523. The above article, published online on 05 December 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons, Ltd. It came to the publisher's attention from a third party that a number of articles shared concerning similarities in format and structure. Following an investigation by the publisher, the retraction has been agreed on as the peer review and publishing process for this article were found to be manipulated. The authors did not respond to the notice of retraction.

Enhanced Recovery after Surgery (ERAS) in Pediatric Cardiac Surgery - Status quo of implementation in Europe

ObjectivesEnhanced Recovery After Surgery (ERAS) is a multimodal care pathway to enhance recovery after surgery that is well established in various surgical disciplines. In pediatric cardiac surgery, implementation of ERAS protocols remains inconsistent. We conducted a survey of active European pediatric cardiac surgical centers to assess the current state of ERAS concepts and the current practice in perioperative pediatric cardiac care. DesignProspective, 79-item, web-based cross-sectional survey. SettingWeb-based survey endorsed by the European Association of Cardiothoracic Anesthesiology and Intensive Care (EACTAIC). ParticipantsAnesthesiologists of European pediatric cardiac surgical centers. InterventionsNone Measurements and Main resultsOut of a total of 98 centers, 50 responded. Eight responses were excluded due to incomplete survey forms or non-European location, leaving 42 responses (42,9%) for statistical analysis. Sixteen of the 42 centers (38,1%) follow an ERAS concept. Only 3 (7,1%) have formalized and detailed the ERAS concept in a written document, covering the entire perioperative period, while 13 (31%) have formalized it solely for the intraoperative period.Regarding regional and local anesthesia, 13 (31%) centers regularly practice regional anesthesia blocks, and 11 (26,2%) centers utilize wound infiltration by the surgical team. ConclusionThis European survey revealed that implementation of ERAS concepts in pediatric cardiac surgery is generally low, with considerable heterogeneity in clinical practice regarding the timing of extubation, the choice of surgical procedures triggering on-table extubation, the choice of anesthetic drugs and the use of regional anesthesia. More coordinated efforts are needed to implement ERAS concepts in pediatric cardiac surgery and harvest the benefits of ERAS concepts for the pediatric cardiac population.

Efficacy of ultrasound-guided bilateral rectus sheath block vs. local anesthetic infiltration in gynecologic oncology patients undergoing midline laparotomy: a triple-blinded randomized controlled trial.

Postoperative pain is a serious problem in gynecological oncology patients. Rectus sheath block (RSB) is increasingly utilized as a part of multimodal analgesia. The purpose of this three blinded, randomized-controlled trial is to compare the analgesic efficacy of ultrasound-guided (US-guided) bilateral rectus sheath block (BRSB) and local anesthetic wound infiltration (LAWI) application in patients undergoing midline laparotomy for gynecologic cancer. This prospective, single-center, three-blinded, randomized clinical trial enrolled a total of 60 patients who underwent surgery through a midline laparotomy. Patients were randomly allocated into two groups and were administered either LAWI or BRSB with 20 mL of 0.25% bupivacaine just after the end of surgery. Both groups were compared for Numeric Rating Scale (NRS) pain scores, time to first analgesic requirement, total tramadol consumption. Fifty-five patients (BRSB=28, LAWI=27) completed the study. The BRSB group had significantly lower NRS scores at 2, 6, 12, and 24th hours (P<0.001). The median (interquartile range, IQR) NRS scores for BRSB group were 3 (3-3) at 2nd hours, 3 (2-4) at 6th hours, 3 (2-4) at 12th hours and 3 (2-3) at 24th hours. For the LAWI group, the median (IQR) NRS scores were 4 (3-4) at 2nd hours, 4 (3-5) at 6th hours, 4 (3-4) at 12th hours and 4 (3-4) at 24th hours. The BRSB group had significantly less additional tramadol consumption than the LAWI group (P<0.001). The US-guided BRSB is a safe and feasible technique. This technique resulted in reduced postoperative pain scores, decreased tramadol usage, and prolonged pain relief compared to LAWI.

Can a Continuous Wound Infiltration System Replace Intravenous Patient-Controlled Analgesia for Postoperative Pain Management after a Single-Port Access Laparoscopy?

Background: The aim of this study was to determine whether continuous wound infiltration (CWI) can replace intravenous patient-controlled analgesia (IV PCA) and to investigate effective pain control strategies after a single-port access (SPA) laparoscopy for adnexal disease. Methods: A total of 470 patients (the CWI group [n = 109], the IV PCA group [n = 198], and the combined group [n = 163]) who underwent an SPA adnexal laparoscopy and who received CWI or IV PCA for postoperative pain management were retrospectively reviewed. The numeric rating scale (NRS) pain score at 6, 12, 24, and 48 h (h) after surgery and the total amount of fentanyl administered via IV PCA were collected. The incidence of postoperative nausea and vomiting (PONV) and the total amount of rescue antiemetic drugs administered were also evaluated. Results: The mean NRS pain scores at 6 h (combined vs. PCA vs. CWI, 3.08 vs. 3.44 vs. 3.96, p < 0.001), 12 h (2.10 vs. 2.65 vs. 2.82, p < 0.001), and 24 h (1.71 vs. 2.01 vs. 2.12, p < 0.001) after surgery were significantly lower in the combined group. CWI showed a similar pain-reduction effect after surgery compared to IV PCA, except for the acute phase (within 6 h after surgery). The incidence of PONV during the entire hospitalization period was significantly lower in the CWI group compared to the groups using IV PCA (p < 0.05). The combined group had a significantly lower incidence of PONV and use of rescue antiemetics than the IV PCA group (p < 0.05). The combined group required significantly less total PCA fentanyl compared to the IV PCA group (combined vs. PCA, 622.1 μg vs. 703.1 μg, p < 0.001). Conclusions: CWI is an effective alternative to IV PCA and has fewer side effects. Combined use of CWI and IV PCA may be an ideal pain management strategy, offering a strong pain-reduction effect and only moderate side effects.

Local ketorolac infiltration for postoperative pain in open trigger finger surgery: a randomized controlled trial

BackgroundMultimodal analgesia is crucial for effective postoperative pain management in minor hand surgeries, enhancing patient satisfaction. The use of local wound infiltration with Ketorolac as an adjuvant pain management strategy is proposed for open trigger finger release surgery. This study aims to compare pain scores and functional outcomes between local wound infiltration with Ketorolac and oral non-steroidal anti-inflammatory drugs.MethodsThis study is a double-blind, parallel design, randomized controlled trials. Sixty-nine patients underwent trigger finger surgery between December 2021 and October 2022 were randomized into one of three groups: oral Ibuprofen alone group, local Ketorolac alone group and local Ketorolac with oral Ibuprofen group. The assessment included postoperative numeric rating scale (NRS) pain score, Disabilities of the Arm, Shoulder, and Hand (DASH) score, grip strength, mobility of proximal interphalangeal (PIP) joint. and complications.ResultsNRS pain scores during movement of the operated fingers were significantly lower at 6 h in local Ketorolac alone group and local Ketorolac with oral Ibuprofen group compared to oral Ibuprofen alone group. However, there were no significant differences between the groups in postoperative DASH scores, grip strength, mobility of PIP joints, and complications.ConclusionsLocal infiltration of Ketorolac as an adjunct in postoperative pain management has been shown to provide superior analgesia during finger movement within the initial 6 h following trigger finger surgery, in comparison to oral NSAIDs.Clinical trial registrationThaiclinicaltrials.org identifier: TCTR20210825002. Registered 25/08/2021. https://www.thaiclinicaltrials.org/show/TCTR20210825002

Effect of Erector Spinae Plane Block on Postoperative Quality of Recovery in Patients Undergoing Transforaminal or Oblique Lumbar Interbody Fusion: A Randomized Controlled Trial.

Erector spinae plane block (ESPB) can has been used for analgesia after lumbar spine surgery. However, its effect on postoperative quality of recovery (QoR) remains underexplored in patients undergoing transforaminal lumbar interbody fusion (TLIF) or oblique lumbar interbody fusion (OLIF). This study hypothesized that ESPB would improve postoperative QoR in this patient cohort. Patients undergoing TLIF or OLIF were randomized into ESPB (n=38) and control groups (n=38). In the ESPB group, 25mL of 0.375% bupivacaine was injected into each erector spinae plane at the T12 level under ultrasound guidance before skin incision. Multimodal analgesia, including wound infiltration, was applied in both groups. The QoR-15 score was measured before surgery and 1 day (primary outcome) and 3 days after surgery. Postoperative pain at rest and during ambulation and postoperative ambulation were also evaluated for 3 days after surgery. Perioperative QoR-15 scores were not significantly different between the ESPB and control groups including at 1 day after surgery (80±28 vs. 81±25, respectively; P=0.897). Patients in the ESPB group had a significantly lower mean (±SD) pain score during ambulation 1 hour after surgery (7±3 vs. 9±1, respectively; P=0.013) and significantly shorter median (interquartile range) time to the first ambulation after surgery (2.0 [1.0 to 5.5]h vs. 5.0 [1.8 to 10.0]h, respectively; P=0.038). There were no between-group differences in pain scores at other times or in the cumulative number of postoperative ambulations. ESPB, as performed in this study, did not improve the QoR after TLIF or OLIF with multimodal analgesia.

Pain management after laparoscopic cholecystectomy: A systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations.

Laparoscopic cholecystectomy can be associated with significant postoperative pain that is difficult to treat. We aimed to evaluate the available literature and develop updated recommendations for optimal pain management after laparoscopic cholecystectomy. A systematic review was performed using the procedure-specific postoperative pain management (PROSPECT) methodology. Randomised controlled trials and systematic reviews published in the English language from August 2017 to December 2022 assessing postoperative pain after laparoscopic cholecystectomy using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, Embase and Cochrane Databases. From 589 full text articles, 157 randomised controlled trials and 31 systematic reviews met the inclusion criteria. Paracetamol combined with NSAIDs or cyclo-oxygenase-2 inhibitors should be given either pre-operatively or intra-operatively, unless contraindicated. In addition, intra-operative intravenous (i.v.) dexamethasone, port-site wound infiltration or intraperitoneal local anaesthetic instillation are recommended, with opioids used for rescue analgesia. As a second-line regional technique, the erector spinae plane block or transversus abdominis plane block may be reserved for patients with a heightened risk of postoperative pain. Three-port laparoscopy, a low-pressure pneumoperitoneum, umbilical port extraction, active aspiration of the pneumoperitoneum and saline irrigation are recommended technical aspects of the operative procedure. The following interventions are not recommended due to limited or no evidence on improved pain scores: single port or mini-port techniques, routine drainage, low flow insufflation, natural orifice transluminal endoscopic surgery (NOTES), infra-umbilical incision, i.v. clonidine, nefopam and regional techniques such as quadratus lumborum block or rectus sheath block. Several interventions provided better pain scores but are not recommended due to risk of side effects: spinal or epidural anaesthesia, gabapentinoids, i.v. lidocaine, i.v. ketamine and i.v. dexmedetomidine.

Update on the Obstetric Anesthesia Practice in Flanders/Belgium: A 10-year follow-up survey and review

Background: With 75% of women receiving neuraxial anesthesia for labor and cesarean section (CS) in Flanders, Belgium, obstetric anesthesia is an essential part of perinatal care. Despite advancements in obstetric anesthesia and guidelines being updated regularly, past surveys have shown great variability among hospitals. Objective: This investigation aims to observe current obstetric anesthesia practices, compare them with previous surveys, and assess adherence to guidelines among anesthesiologists. Methods: An online questionnaire-based survey, approved by the KU Leuven Ethics Committee, was conducted focusing on three main topics: analgesia during labor, anesthesia for CS, and postoperative analgesia after CS. The survey, consisting of 127 questions, was distributed via email to the heads of anesthesia departments in 57 Flemish hospitals providing obstetric anesthesia care. Responses were anonymously analyzed. Results: For labor analgesia initiation, a conventional epidural with administration of ropivacaine 0.2% (+- sufentanil) remains the most widespread used technique, although Combined-Spinal Epidural (CSE) has gained significant popularity. Patient-controlled epidural analgesia (PCEA) in combination with continuous epidural infusion (CEI) is the preferred maintenance method, however programmed-intermittent bolus (PIEB) has found its way into standard practice. CSs are mostly done by performing CSE or single shot spinal, using hyperbaric bupivacaine 0.5% with sufentanil. Spinal-induced hypotension is treated with a combination of left lateral tilt, fluid administration and vasopressor administration, usually as a bolus. Post-CS pain is mainly treated by a combination of oral/ parenteral analgesics and neuraxial analgesia (PCEA +- CEI), with only a minority choosing regional techniques such as wound infiltration, transverse abdominal plane blocks, quadratus lumborum blocks, etc. Conclusion: Compared to previous surveys, the Flemish anesthesiologists adhere well to the latest guidelines and gold standards in obstetric anesthesia, consistently modernizing their practices. Nevertheless, with the continual introduction of novel techniques and methods, it is imperative for practitioners to maintain efforts in pursuing ongoing innovation.

Efficacy of locoregional analgesic techniques after laparotomy for gynecologic cancer: a systematic review

ObjectiveTo determine which locoregional techniques are effective in managing post-operative pain in major open oncologic gynecologic surgery in terms of pain scores and opioid consumption when epidural analgesia is not...