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Chen IC, Kang YN, Wang HJ, Chiu WK, Chen C. The Efficacy of Local Anesthesia for Postoperative Pain Control in Breast Augmentation Surgery: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Aesthetic Plast Surg 2022; 46:1106-1115. [PMID: 35274178 DOI: 10.1007/s00266-022-02815-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 01/27/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Breast augmentation can cause severe postoperative pain; therefore, some surgeons perform wound infiltration with a local anesthetic solution. This study investigated the postoperative pain relief of local analgesics in breast augmentation surgery. METHODS We searched three databases for randomized controlled trials evaluating the outcomes of local wound irrigation with local analgesics during or after breast augmentation surgery. The solutions included ropivacaine, bupivacaine, bupivacaine plus ketorolac. The control groups may be saline alone or no irrigation. Network meta-analysis was further employed based on the frequentist approach. Outcomes were reported as weighted mean differences with 95% confidence intervals. RESULTS Comparisons between the interventions of our included studies revealed that only bupivacaine plus ketorolac (versus placebo) significantly reduced pain at 1 h postoperatively, as indicated by the visual analog scale pain score reduction of 2.22 (- 3.98, - 0.47). Other comparisons showed no significant differences. Moreover, three of the included studies reported postoperative medication use. Two of them reported that postoperative narcotic use was reduced, but the others did not report any such reduction. CONCLUSIONS Our results showed possibility that local irrigation with bupivacaine plus ketorolac might reduce pain 1 h after surgery. In addition, local anesthesia might reduce postoperative narcotic use. However, due to the small number of included studies, the clinical benefits of local anesthesia in breast augmentation surgery require further confirmation. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- I-Chun Chen
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, 110, Taiwan
| | - Yi-No Kang
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Research Center of Big Data and Meta-analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsian-Jenn Wang
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chiehfeng Chen
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan.
- Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
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Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review. J Clin Med 2021; 10:jcm10204659. [PMID: 34682777 PMCID: PMC8537195 DOI: 10.3390/jcm10204659] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/03/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.
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Abstract
BACKGROUND Suboptimal pain management is a common, yet largely unrecognized, problem in the postsurgical patient population. Current treatment protocols heavily rely on opioid use and, though generally effective in providing pain relief, are associated with multiple side effects. The present systematic review aims to offer plastic surgeons insight into the current state of literature on prolonged local anesthetic wound infusion regimens, evaluating both their efficacy in lowering pain scores and the potential opioid-sparing effect. METHODS A comprehensive literature search of the Medline, Embase, and Cochrane Library databases was performed to identify relevant studies published between 1980 and December 2017 evaluating the use of prolonged local anesthetic wound infusion for postoperative pain management in plastic surgery. RESULTS A total of 28 articles were selected, including 3904 patients. The overall infection rate in all patients treated with postsurgical local anesthetic wound infiltration was 0.28% (7/2536). There were no reported cases of systemic toxicity. An opioid-sparing effect was found in 92% (12/13) of studies when compared to an active comparator and 88% (7/8) of those comparing to placebo. Pain scores were decreased in 90% (9/10) of studies comparing wound infiltration to narcotic-based regimens and in 67% (6/9) of those comparing to placebo. CONCLUSIONS Continuous or intermittent wound infusion is safe and effective in reducing pain scores and opioid consumption in plastic surgery. Though the overall pain-lowering effect appears to be modest, ease of catheter insertion and patient satisfaction make this technique an alluring alternative to more validated approaches such as neuraxial or peripheral nerve blocks.
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Ropivacaine in Breast Augmentation Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1745. [PMID: 29922549 PMCID: PMC5999429 DOI: 10.1097/gox.0000000000001745] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 02/12/2018] [Indexed: 11/27/2022]
Abstract
Background: Breast augmentation surgery is still 1 of the most popular procedures in plastic surgery. Like other surgical procedures, it has been traditionally handled with nonsteroidal anti-inflammatory drugs and narcotics, which had many adverse effects; therefore, alternatives with the same effectiveness are being researched. The aim of this study was to investigate the efficacy of ropivacaine breast pocket irrigation during primary breast augmentation surgery to control pain during the first postoperative hours. Methods: A multicenter, prospective, double-blind, randomized trial was performed on 52 primary breast augmentation procedures in which patients served as their own control: One breast received ropivacaine pocket irrigation and the other placebo. All patients received an oral analgesic. Pain was evaluated with a visual analogue scale at 30, 60, 90, and 120 minutes postoperatively. Results: Pain was significantly less in ropivacaine breast at 90 and 120 minutes postoperatively (P = 0.027 and 0.022, respectively). There was no statistical significance when the type of anesthesia used, general or epidural, was compared (P = 0.33 and P = 0.37 at 90 and 120 minutes, respectively). Conclusions: Ropivacaine irrigation in breast pocket is able to diminish early postoperative pain safely, being an alternative to other analgesic methods.
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Wang J, Zhang C, Tan D, Tan G, Yang B, Chen W, Tang G. The Effect of Local Anesthetic Infiltration Around Nephrostomy Tract on Postoperative Pain Control after Percutaneous Nephrolithotomy: A Systematic Review and Meta-Analysis. Urol Int 2016; 97:125-33. [DOI: 10.1159/000447306] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/09/2016] [Indexed: 11/19/2022]
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Shim M, Park M, Park HK. Effects of Continuous Peritubal Local Anesthetic Instillation on Postoperative Pain After Percutaneous Nephrolithotomy: A Prospective, Randomized Three-Arm Study. J Endourol 2016; 30:504-9. [PMID: 26901237 DOI: 10.1089/end.2015.0847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE We evaluated the effects of continuous instillation of a local anesthetic at the nephrostomy site on postoperative pain following percutaneous nephrolithotomy (PCNL). PATIENTS AND METHODS Sixty patients who underwent PCNL between August 2013 and March 2015 were enrolled in this randomized prospective study. The following three groups comprising 20 patients each were analyzed: Group A, continuous infiltration of local anesthetic at the nephrostomy site; Group B, local anesthetic injected only once; and Group C, 0.9% saline injected as a control at the end of the procedure. Postoperative patients reported pain scores, and amount of analgesic use was recorded at 2, 6, 12, 24, and 48 hours after the surgery. RESULTS The mean pain scores of patients in Group A and B were significantly lower compared with Group C patients as much as 12 hours postoperatively (p = 0.001). However, at 24 hours postoperatively, the mean pain scores of Group B and C patients became comparable, while those of Group A patients remained significantly lower until 48 hours after the surgery (p < 0.001). Patients in Group A and C demanded the least and greatest amounts of analgesics, respectively, at all-time intervals (all p < 0.05). CONCLUSIONS Continuous infiltration of a local anesthetic is effective for both managing pain immediately after surgery and in dealing with pain that occurs late in the recovery period.
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Affiliation(s)
- Myungsun Shim
- 1 Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine , Anyang, Korea
| | - Myungchan Park
- 2 Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
| | - Hyung Keun Park
- 2 Department of Urology, Asan Medical Center, University of Ulsan College of Medicine , Seoul, Korea
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Cost-effectiveness analysis of levobupivacaine 0.5 %, a local anesthetic, infusion in the surgical wound after modified radical mastectomy. Clin Drug Investig 2015; 35:575-82. [PMID: 26305021 DOI: 10.1007/s40261-015-0316-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVE Effective treatment of postoperative pain contributes to decreasing the rate of complications as well as the total cost of the operated patients. The aim of this study was to analyze the costs and the efficiency of use of continuous infusion of levobupivacaine 0.5 % with the help of an infusion pump in modified radical mastectomy. METHODS A cost calculation of the analgesic procedures (continuous infusion of levobupivacaine 0.5 % [levobupivacaine group (LG)] or saline [saline group (SG)] (2 ml/h 48 h) has been carried out based on the data of a previous clinical trial (double-blind randomized study) of patients who underwent modified radical mastectomy surgery. The measure of the effectiveness was the point reduction of pain derived from the verbal numeric rating scale (VNRS). The usual incremental cost-effectiveness ratio (ICER) was performed. RESULTS Considering only the intravenous analgesia, overall costs were lower in LG, as less analgesia was used (EUR14.06 ± 7.89 vs. 27.47 ± 14.79; p < 0.001). In this study the costs of the infusion pump were not calculated as it was used by both groups and they offset each other. However, if the infusion pump costs were included, costs would be higher in the LG, (EUR91.89 ± 7.89 vs. 27.47 ± 14.79; p < 0.001) and then the ICER was -8.51, meaning that for every extra point of decrease in the pain verbal numerical rating score over the 2-day period, the cost increased by EUR8.51. CONCLUSION Infiltration of local anesthetics is an effective technique for controlling postoperative pain and the associated added costs are relatively low in relation to the total cost of mastectomy, therefore providing patients with a higher quality of care in the prevention of pain. CLINICAL TRIALS REGISTRATION clinicaltrials.gov: reference number NCT01389934. http://clinicaltrials.gov/show/NCT01389934
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Postoperative Analgesia by Infusion of Local Anesthetic into the Surgical Wound after Modified Radical Mastectomy. Plast Reconstr Surg 2014; 134:862e-870e. [DOI: 10.1097/prs.0000000000000762] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Raines S, Hedlund C, Franzon M, Lillieborg S, Kelleher G, Ahlén K. Ropivacaine for Continuous Wound Infusion for Postoperative Pain Management: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Eur Surg Res 2014; 53:43-60. [DOI: 10.1159/000363233] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/28/2014] [Indexed: 11/19/2022]
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Strazisar B, Besic N, Ahcan U. Does a continuous local anaesthetic pain treatment after immediate tissue expander reconstruction in breast carcinoma patients more efficiently reduce acute postoperative pain--a prospective randomised study. World J Surg Oncol 2014; 12:16. [PMID: 24433317 PMCID: PMC3899444 DOI: 10.1186/1477-7819-12-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/25/2013] [Indexed: 11/21/2022] Open
Abstract
Background Immediate breast reconstruction with an expander is a reasonable option for properly selected patients. After reconstruction, patients have severe postoperative pain, which responds poorly to opioids. Our aim was to evaluate if continuous wound infusion of a local anaesthetic into the surgical wound reduces postoperative pain, consumption of opioids and incidence of chronic pain compared to standard intravenous piritramide after primary breast reconstruction in breast carcinoma patients. Methods Altogether, 60 patients were enrolled in our study; one half in the group with wound infusion of a local anaesthetic, and the other half in the standard (piritramide) group. Parameters measured included: pain intensity (visual analogue scale), drug requirements, alertness, hospitalisation, side-effects and late complications. A p-value of < 0.05 was considered statistically significant. Results In the recovery room, the test group reported less acute pain at rest (P = 0.03) and at activity (P = 0.01), and on the day of the surgical procedure they reported less pain at activity (P = 0.003). Consumption of piritramide and metoclopramide was lower in this group (P < 0.0001), but their alertness after the surgical procedure was higher compared to the standard group (P < 0.001). After three months, the test group reported less chronic pain (P = 0.01). Conclusions After primary tissue expander breast reconstruction, wound infusion of a local anaesthetic significantly reduces acute pain and enables reduced opioid consumption, resulting in less postoperative sedation and reduced need for antiemetic drugs. Wound infusion of a local anaesthetic reduces chronic pain.
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Affiliation(s)
- Branka Strazisar
- Department of Anaesthesiology, Institute of Oncology, Zaloska 2, Ljubljana SI-1000, Slovenia.
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Stanley SS, Hoppe IC, Ciminello FS. Pain control following breast augmentation: a qualitative systematic review. Aesthet Surg J 2012; 32:964-72. [PMID: 22914699 DOI: 10.1177/1090820x12457014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Breast augmentation is among the most popular plastic surgery procedures in the United States. Postoperative pain management following breast surgery has traditionally involved intravenous and oral narcotics. However, pain control is not always adequately achieved through these means and may cause unwanted side effects, including headache, nausea, vomiting, constipation, altered mental status, sleep disturbance, and respiratory depression. Alternative forms of pain control have been used successfully in other surgical fields but have been utilized only recently in breast surgery. In this article, the authors systematically review the existing database of high-quality studies involving pain control following cosmetic breast augmentation to determine the best options currently available.
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Affiliation(s)
- Sharon S Stanley
- Department of Surgery, Division of Plastic Surgery, New Jersey Medical School-UMDNJ, Newark, 07103, USA
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Lavand'homme P. Improving postoperative pain management: Continuous wound infusion and postoperative pain. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.eujps.2011.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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American Society of Regional Anesthesia and Pain Medicine 2010 Gaston Labat Lecture. Reg Anesth Pain Med 2012; 37:72-8. [DOI: 10.1097/aap.0b013e31823ba9d2] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kfoury T, Mazoit JX, Schumacher M, Benhamou D, Beloeil H. A comparison of different dosages of a continuous preperitoneal infusion and systemic administration of ropivacaine after laparotomy in rats. Anesth Analg 2011; 113:617-25. [PMID: 21596868 DOI: 10.1213/ane.0b013e31821f108a] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION To further explain the mechanisms of action involved in the analgesic effect of a local anesthetic wound infusion, we evaluated parietal and visceral sensitivity as well as indices of inflammation after laparotomy and administration of a local anesthetic. Ropivacaine was administered at different dosages by a continuous infusion using a multiholed catheter in the preperitoneal position or systemically in rats. METHODS Nine groups of rats received 2 injections after laparotomy or sham surgery: (1) a bolus injection (ropivacaine or saline) via a preperitoneal catheter and (2) an IM injection (IM) (ropivacaine or saline). These injections were followed by a continuous infusion (ropivacaine or saline) in the preperitoneal catheter for 24 hours and 1 IM injection every 8 hours. Mechanical and visceral thresholds after stimulation were evaluated 3 times during the 48 hours after surgery. Stimulated production of tumor necrosis factor α, and interleukin 1β in whole-blood cultures were measured by enzyme-linked immunosorbent assay. The ropivacaine plasma concentration was measured by gas chromatography. RESULTS Preperitoneal infusion of high doses of ropivacaine and systemic ropivacaine similarly prevented mechanical and visceral sensitivity alterations and led to a better functional recovery. The analgesic effect of systemic administration was associated with an anti-inflammatory effect. CONCLUSION In the current study, high-dose ropivacaine administered via a preperitoneal infusion or systemic boluses had the same effect on mechanical and visceral sensitivity after laparotomy. Moreover, systemic administration was associated with an anti-inflammatory effect. The merits of the comparable benefit of systemic and high-dose preperitoneal infusion of ropivacaine need to be confirmed with further studies.
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Affiliation(s)
- Toni Kfoury
- Université Paris-Sud, Laboratoire d'Anesthesie, INSERM U788, Departement d'anesthesie, 78 av du general leclerc, F-94276 Le Kremlin Bicêtre, France
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Gupta A, Rawal N, Magnuson A, Alnehill H, Pettersson K. Patient controlled regional analgesia after carpal tunnel release: a double-blind study using distal perineural catheters. J Hand Surg Eur Vol 2011; 36:219-25. [PMID: 21148606 DOI: 10.1177/1753193410390130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
This study was done to assess the efficacy of a perineural catheter for pain relief following carpal tunnel release (CTR). Sixty-six patients undergoing open CTR under local anaesthesia (LA) were randomly divided into three groups: Groups A and B had a perineural catheter and Group C served as non-blinded control group. Postoperative pain relief was by self-administration of either ropivacaine (Group A) or saline (Group B) via an elastometric pump and by oral paracetamol in Group C. Patients in Group A had a significantly greater difference in summed pain intensity than Group B. Fewer patients in Group A requested supplementary analgesics than in Group C. Patient satisfaction was higher in Group A than in Group B on day 1. However better analgesia was not associated with better functional recovery.
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Affiliation(s)
- Anil Gupta
- Department of Anesthesiology and Intensive Care, Institution for Clinical Medicine, University Hospital, Örebro and University of Linköping, Sweden.
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Utvoll J, Beausang-Linder M, Mesic H, Raeder J. Brief report: improved pain relief using intermittent bupivacaine injections at the donor site after breast reconstruction with deep inferior epigastric perforator flap. Anesth Analg 2010; 110:1191-4. [PMID: 20142346 DOI: 10.1213/ane.0b013e3181cf05f5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Deep inferior epigastric perforator flap surgery usually results in postoperative pain from the donor site requiring opioids. METHOD We examined the effect of bupivacaine 2.5 mg/mL, 20 mL given every third hour for 72 hours postoperatively through 2 thin catheters placed on the donor site in a double-blind placebo-controlled study consisting of 2 x 20 patients. RESULTS The bupivacaine group had significantly reduced pain at rest and during coughing. The placebo group needed 2 to 3 times more opioids in the 72-hour observation period. No difference was seen in the frequency of nausea or the consumption of antiemetic drugs. CONCLUSION We conclude that intermittent delivery of bupivacaine at the abdominal donor site significantly reduces the postoperative pain and need for narcotic rescue medication.
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Affiliation(s)
- Jørgen Utvoll
- Department of Plastic and Maxillofacial Surgery, Ullevaal University Hospital, Oslo, Kirkeveien 166, 0407 Oslo, Norway.
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Legeby M, Jurell G, Beausang-Linder M, Olofsson C. Placebo-controlled trial of local anaesthesia for treatment of pain after breast reconstruction. ACTA ACUST UNITED AC 2009; 43:315-9. [DOI: 10.1080/02844310903259108] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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New and emerging analgesics and analgesic technologies for acute pain management. Curr Opin Anaesthesiol 2009; 22:608-17. [DOI: 10.1097/aco.0b013e32833041c9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Beaussier M, Aissou M. Infiltrations continues cicatricielles ou intra-articulaires pour l’analgésie postopératoire. ACTA ACUST UNITED AC 2009; 28:e153-62. [DOI: 10.1016/j.annfar.2009.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Irrigación de anestésicos locales y dolor postoperatorio en pacientes sometidas a mamoplastia de aumento. COLOMBIAN JOURNAL OF ANESTHESIOLOGY 2008. [DOI: 10.1016/s0120-3347(08)63006-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Effects of pulsed electromagnetic fields on postoperative pain: a double-blind randomized pilot study in breast augmentation patients. Aesthetic Plast Surg 2008; 32:660-6. [PMID: 18506512 DOI: 10.1007/s00266-008-9169-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Accepted: 04/14/2008] [Indexed: 10/22/2022]
Abstract
BACKGROUND Postoperative pain may be experienced after breast augmentation surgery despite advances in surgical techniques which minimize trauma. The use of pharmacologic analgesics and narcotics may have undesirable side effects that can add to patient morbidity. This study reports the use of a portable and disposable noninvasive pulsed electromagnetic field (PEMF) device in a double-blind, randomized, placebo-controlled pilot study. This study was undertaken to determine if PEMF could provide pain control after breast augmentation. METHODS Forty-two healthy females undergoing breast augmentation for aesthetic reasons entered the study. They were separated into three cohorts, one group (n = 14) received bilateral PEMF treatment, the second group (n = 14) received bilateral sham devices, and in the third group (n = 14) one of the breasts had an active device and the other a sham device. A total of 80 breasts were available for final analysis. Postoperative pain data were obtained using a visual analog scale (VAS) and pain recordings were obtained twice daily through postoperative day (POD) 7. Postoperative analgesic medication use was also followed. RESULTS VAS data showed that pain had decreased in the active cohort by nearly a factor of three times that for the sham cohort by POD 3 (p < 0.001), and persisted at this level to POD 7. Patient use of postoperative pain medication correspondingly also decreased nearly three times faster in the active versus the sham cohorts by POD 3 (p < 0.001). CONCLUSION Pulsed electromagnetic field therapy, adjunctive to standard of care, can provide pain control with a noninvasive modality and reduce morbidity due to pain medication after breast augmentation surgery.
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Current World Literature. Curr Opin Anaesthesiol 2007; 20:605-9. [DOI: 10.1097/aco.0b013e3282f355c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Haleblian GE, Sur RL, Albala DM, Preminger GM. Subcutaneous Bupivacaine Infiltration and Postoperative Pain Perception After Percutaneous Nephrolithotomy. J Urol 2007; 178:925-8. [PMID: 17632138 DOI: 10.1016/j.juro.2007.05.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Indexed: 11/25/2022]
Abstract
PURPOSE Recent studies have shown a significant decrease in patient reported pain scores when the nephrostomy tube size is decreased from 22 to 10Fr. We hypothesize that patient reported pain and narcotic use could be further decreased for patients with post-percutaneous nephrolithotomy nephrostomy tubes if the incision is infiltrated with a local anesthetic. MATERIALS AND METHODS A randomized prospective trial was designed to assess the impact of Marcaine infiltration of the nephrostomy tract following percutaneous stone removal. Patients undergoing single access percutaneous nephrolithotomy were randomized to have a fixed volume of saline or weight based concentration of Marcaine infiltrated into the nephrostomy tube tract at the conclusion of the procedure. Postoperative narcotic use and patient reported pain scores were then obtained at 2, 4, 24 and 48 hours postoperatively. RESULTS A total of 25 patients were enrolled in the study with 3 excluded from analysis due to incomplete data collection (2) or the development of hydrothorax (1). Of the 22 patients analyzed 10 were in the Marcaine cohort and 12 were in the saline cohort. Patient pain scores at 2, 4, 24 and 28 hours for the Marcaine group were 5, 4.2, 3.6 and 2.6, while for the saline group scores were 3.3, 3.1, 2.3 and 3.5. At all points differences between the groups were not statistically significant (p >0.05). Mean postoperative narcotic use was 24.7 mg morphine sulfate in the Marcaine group and 32.1 mg morphine sulfate in the control cohort (p >0.05). CONCLUSIONS In this preliminary pilot study no significant differences in patient reported pain scores were observed. However, a trend toward decreased postoperative narcotic use was seen in patients receiving subcutaneous Marcaine administration around the nephrostomy tube tract. Further studies are warranted to define additional measures to reduce discomfort in those requiring nephrostomy tube drainage following percutaneous nephrolithotomy.
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Affiliation(s)
- George E Haleblian
- Comprehensive Kidney Stone Center, Division of Urologic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA.
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