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Das D, Chauhan S, Gayatri S, Chaudhury M, Makhija N, Bisoi AK. Efficacy of Incisional Ropivacaine Infiltration by Presternal Multi-Orifice Catheter for Post-sternotomy Pain Relief in Pediatric Patients Undergoing Cardiac Surgery: A Prospective, Randomized, Controlled Study. J Cardiothorac Vasc Anesth 2023; 37:2282-2288. [PMID: 37558558 DOI: 10.1053/j.jvca.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/04/2023] [Accepted: 07/07/2023] [Indexed: 07/19/2023]
Abstract
OBJECTIVE To evaluate the efficacy of incisional ropivacaine infiltration by presternal multi-orifice catheter to manage poststernotomy pain in pediatric cardiac surgery. DESIGN A prospective, randomized, and double-blind comparative study. SETTING At a single-institution tertiary referral cardiac center. PARTICIPANTS The study comprised 200 children undergoing cardiac surgeries through a midline sternotomy. INTERVENTIONS Children were allocated randomly to 1 of 3 groups. Group A (n = 65) and group B (n = 64) received 0.375% ropivacaine infusion and intermittent bolus, respectively, by presternal multi-orifice catheter, whereas Group C (n = 64) did not receive any local anesthetic (LA) drug. Postoperatively, intravenous paracetamol was used for multimodal analgesia, and fentanyl was given as rescue analgesia, respectively. MEASUREMENTS AND MAIN RESULTS Pain was assessed by a Modified Objective Pain Score (MOPS) for 48 hours postextubation. Group B had significantly lower early MOPS at the first hour, but in the later period, the mean MOPS was lower in group A. The requirement of the first rescue analgesia was 3 ± 1.51, 6.1 ± 2.26, and 2.6 ± 0.87 hours for groups A (n = 60), B (n = 60), and C (n = 60), respectively. The 48-hour fentanyl consumption was significantly lower (p < 0.001) in group A (0.5 ± 0.68 µg/kg) and group B (0.7 ± 0.86 µg/kg) than the control group (3.4 ± 0.68 µg/kg). The length of intensive care unit stay was lower (p < 0.001) in groups A and B than in group C; however, the length of hospital stay was comparable (p = 0.07). CONCLUSION LA bolus and infusion through presternal multi-orifice catheter provided effective analgesia postoperatively. However, the bolus was more efficacious in the early phase but equivalent in later periods. Therefore, bolus and LA infusion can be used for steady poststernotomy pain relief in children undergoing cardiac surgeries.
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Affiliation(s)
- Devishree Das
- Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India.
| | - Sandeep Chauhan
- Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Sushama Gayatri
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Minati Chaudhury
- Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Neeti Makhija
- Department of Cardiac Anesthesia and Critical Care, Cardiothoracic Centre, AIIMS, New Delhi, India
| | - Akshay K Bisoi
- Department of Cardiothoracic and Vascular Surgery, Cardiothoracic Centre, AIIMS, New Delhi, India
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Brioschi FA, Ravasio G, Ferrari F, Amari M, Di Cesare F, Valentini Visentin M, Rabbogliatti V. Comparison of intraperitoneal and incisional lidocaine or ropivacaine irrigation for postoperative analgesia in dogs undergoing major abdominal surgeries. PLoS One 2023; 18:e0284379. [PMID: 37053210 PMCID: PMC10101502 DOI: 10.1371/journal.pone.0284379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 03/29/2023] [Indexed: 04/14/2023] Open
Abstract
This study compared the postoperative analgesic efficacy of intraperitoneal and incisional lidocaine versus ropivacaine in dogs undergoing major abdominal surgeries. Dogs randomly received intraperitoneal lidocaine irrigation (4 mg kg-1, diluted to 5 ml kg-1, L group), ropivacaine (4 mg kg-1, diluted to 5 ml kg-1, R group) or 0.9% saline (5 ml kg-1, C group). Prior to skin closure, dogs received incisional lidocaine 2 mg kg-1 (group L), incisional ropivacaine 2 mg kg-1 (group R) or incisional saline 0.2 ml kg-1 (group C). Pain was assessed at different time points up to 24 hours after extubation, using the Short Form-Glasgow Composite Measure Pain Scale and VAS Scale. In group C, postoperative pain scores were significantly higher than in groups L and R from T0.5 to T6 (p < 0.05). In R group, postoperative pain scores were significantly lower than in groups L and C from T12 to T24 (p < 0.05). Rescue analgesia was administered to 5/11 dogs in L group, 1/10 dogs in R group and 8/10 dogs in C group. Groups L and R experienced a significantly lower postoperative pain during the first 6 hours after extubation, compared with group C. Ropivacaine provided lower postoperative pain scores than lidocaine and saline up to 24 hours after extubation. According to the obtained results, ropivacaine seemed to provide better and longer lasting postoperative analgesia compared with lidocaine. Therefore, intraperitoneal and incisional administration of ropivacaine in dogs undergoing major abdominal surgeries is recommended.
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Affiliation(s)
| | - Giuliano Ravasio
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Francesco Ferrari
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Martina Amari
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Federica Di Cesare
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
| | | | - Vanessa Rabbogliatti
- Department of Veterinary Medicine and Animal Sciences, Università Degli Studi Di Milano, Milan, Italy
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Local wound infiltration with a mixture of tramadol and bupivacaine versus bupivacaine alone in those undergoing lower abdominal surgery: Prospective cohort study, 2020. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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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: 29] [Impact Index Per Article: 9.7] [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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Chang YJ, Liu KS, Wang JJ, Hung CH, Chen YW. Chloroquine for prolonged skin analgesia in rats. Neurosci Lett 2020; 735:135233. [PMID: 32622927 DOI: 10.1016/j.neulet.2020.135233] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 06/04/2020] [Accepted: 07/01/2020] [Indexed: 11/30/2022]
Abstract
The purpose of this study was to investigate the ability of chloroquine and chloroquine in combination with vasoconstrictor epinephrine to act as a local anesthetic in skin analgesia. After subcutaneous injection of drugs in rats, the inhibition of the cutaneous trunci muscle reflex (CTMR) is designed for evaluation of the cutaneous analgesic effect. The analgesic effect of chloroquine was compared with that of bupivacaine or coadministration of chloroquine and epinephrine. Chloroquine produced exactly the same local anesthesia as bupivacaine did in a dose-dependent manner. On the ED50 (50 % effective dose) basis, the analgesic potency was chloroquine (4.81 [4.45-5.20] μmol) < bupivacaine (0.46 [0.40‒0.52] μmol) (p < 0.01). At every equipotent dose tested (ED25, ED50 and ED75), chloroquine had a longer duration of cutaneous analgesia than bupivacaine (p < 0.01). Epinephrine enhanced the potency and duration of chloroquine-induced cutaneous analgesia. We found that chloroquine and bupivacaine elicit dose-dependent cutaneous analgesia. Chloroquine is not as potent as bupivacaine, but acts as an infiltrative anesthetic for a longer duration of time and is more potent and effective when used in combination with epinephrine.
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Affiliation(s)
- Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Sheng Liu
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Allied AI Biomed Center, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yu-Wen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan.
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Moulder JK, Boone JD, Buehler JM, Louie M. Opioid Use in the Postoperative Arena: Global Reduction in Opioids After Surgery Through Enhanced Recovery and Gynecologic Surgery. Clin Obstet Gynecol 2019; 62:67-86. [PMID: 30407228 DOI: 10.1097/grf.0000000000000410] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Enhanced recovery programs aim to reduce surgical stress to improve the patient perioperative experience. Through a combination of multimodal analgesia and maintaining a physiological state, postoperative recovery is improved. Many analgesic adjuncts are available that improve postoperative pain control and limit opioid analgesia requirements. Adjuncts are often used in combination, but different interventions may be incorporated for patient-specific and procedure-specific needs. Postoperative pain control can be optimized by continuing nonopioid adjuncts, and prescribing opioid analgesia to address breakthrough pain. Prescribing practices should balance optimizing pain relief, minimizing the risk of chronic pain, while limiting the potential for opioid misuse.
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Affiliation(s)
| | | | - Jason M Buehler
- Anesthesiology, University of Tennessee Medical Center Knoxville, Graduate School of Medicine, Knoxville, Tennessee
| | - Michelle Louie
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, North Carolina
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Chou AK, Chiu CC, Chen YW, Wang JJ, Hung CH. Phentolamine Reverses Epinephrine-Enhanced Skin Antinociception of Dibucaine in Rats. Anesth Analg 2019; 128:1336-1343. [PMID: 31094809 DOI: 10.1213/ane.0000000000003421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The objective of the experiment was to assess the antinociceptive effect of dibucaine, bupivacaine, and epinephrine. To assess the mechanism of action of the interaction between dibucaine and epinephrine, phentolamine, a nonselective α-adrenergic antagonist, was added to the mixture. METHODS We assessed sensory blockade with these drugs by injecting 0.6 mL of drug-in-saline in the dorsal thoracolumbar area of rats; pinprick of the "wheal" formed by the injectate was the area targeted for stimulation to elicit a cutaneous trunci muscle reflex. The sensory block of dibucaine was compared with that of bupivacaine or epinephrine. Drug-drug interactions were analyzed by isobologram. Phentolamine was added to investigate the antinociceptive effect of dibucaine coinjected with epinephrine. RESULTS We demonstrated that dibucaine, epinephrine, and bupivacaine produced dose-dependent skin antinociception. On the median effective dose (ED50) basis, the potency was higher for epinephrine (mean, 0.011 [95% confidence interval {CI}, 0.007-0.015] μmol) than for dibucaine (mean, 0.493 [95% CI, 0.435-0.560] μmol) (P < .01), while there were no significant differences between dibucaine and bupivacaine (mean, 0.450 [95% CI, 0.400-0.505] μmol). On the equipotent basis (75% effective dose, median effective dose, and 25% effective dose), sensory block duration provoked by epinephrine was greater (P < .01) than that provoked by dibucaine or bupivacaine. Coadministration of dibucaine with epinephrine produced a synergistic nociceptive block, whereas phentolamine blocked that synergistic block. CONCLUSIONS The preclinical data indicated that there is no statistically significant difference between the potency and duration of dibucaine and bupivacaine in this model. Epinephrine synergistically enhances the effects of dibucaine, while phentolamine partially blocked those effects. α-Adrenergic receptors play an important role in controlling synergistic analgesic effect of dibucaine combined with epinephrine.
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Affiliation(s)
- An-Kuo Chou
- From the Department of Anesthesiology, China Medical University Hospital, Taichung, Taiwan, Republic of China
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan, Republic of China
| | - Chong-Chi Chiu
- Department of General Surgery, Chi-Mei Medical Center, Tainan and Liouying, Taiwan, Republic of China
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan, Republic of China
| | - Yu-Wen Chen
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan, Republic of China
- Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan, Republic of China
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan, Republic of China
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan, Republic of China
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Mekawy NM, Badawy SS, Sakr SA. Role of postoperative continuous subfascial bupivacaine infusion after posterior cervical laminectomy: Randomized control study. EGYPTIAN JOURNAL OF ANAESTHESIA 2019. [DOI: 10.1016/j.egja.2011.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Tzeng JI, Chiu CC, Wang JJ, Chen YW, Hung CH. Isobolographic analysis of the cutaneous antinociceptive interaction between bupivacaine co-injected with serotonin in rats. Pharmacol Rep 2017. [PMID: 28623708 DOI: 10.1016/j.pharep.2017.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this experiment was to investigate a long-lasting local anesthetic bupivacaine combined with serotonin at inducing cutaneous antinociception. METHODS The skin antinociception, characterized by an inhibition of the cutaneous trunci muscle reflex (CTMR) following the pinprick on the dorsal skin of rats, was evaluated. The cutaneous antinociceptive effects of bupivacaine alone, serotonin alone, or bupivacaine co-injected with serotonin in a dose-dependent fashion were constructed, while the drug-drug interactions were evaluated by isobologram. RESULTS Subcutaneous serotonin, as well as the local anesthetic bupivacaine provoked dose-related cutaneous antinociception. On an equipotent basis (50% effective dose [ED50]), the relative potency was bupivacaine (0.43 [0.37-0.50] μmol)>serotonin (1.27 [1.15-1.40] μmol) (p<0.01). At the equi-anesthetic doses (ED75, ED50 and ED25), the duration of bupivacaine was similar to that of serotonin at producing cutaneous antinociceptive effects. Co-administration of bupivacaine and serotonin displayed a synergistic antinociception. CONCLUSIONS The preclinical data demonstrated that serotonin is less potent in eliciting cutaneous antinociceptive effects but has the similar duration of action, compared with bupivacaine. We also found a more significant depth of the sensory block with bupivacaine+serotonin than bupivacaine alone.
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Affiliation(s)
- Jann-Inn Tzeng
- Department of Anesthesiology, Chi Mei Medical Center, Yong Kang, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Wen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Health Care, China Medical University, Taichung, Taiwan.
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Chen YW, Shieh JP, Liu KS, Wang JJ, Hung CH. Naloxone prolongs cutaneous nociceptive block by lidocaine in rats. Fundam Clin Pharmacol 2017; 31:636-642. [PMID: 28677297 DOI: 10.1111/fcp.12302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 06/08/2017] [Accepted: 06/30/2017] [Indexed: 11/26/2022]
Abstract
We aimed to investigate the local anesthetic properties of naloxone alone or as an adjunct for the local anesthetic lidocaine. After the block of the cutaneous trunci muscle reflex (CTMR) with drugs delivery by subcutaneous infiltration, cutaneous nociceptive block was tested on the ratsꞌ backs. We demonstrated that naloxone, as well as lidocaine, elicited cutaneous analgesia dose-dependently. The relative potency in inducing cutaneous analgesia was lidocaine [22.6 (20.1 - 25.4) μmol/kg] > naloxone [43.2 (40.3 - 46.4) μmol/kg] (P < 0.05). On an equianesthetic basis [50% effective dose (ED50 ), ED25 , and ED75 ], naloxone displayed a greater duration of cutaneous analgesic action than lidocaine (P < 0.01). Coadministration of lidocaine (ED95 or ED50 ) and ineffective-dose naloxone (13.3 μmol/kg) intensifies sensory block (P < 0.01) with prolonged duration of action (P < 0.001) compared with lidocaine (ED95 or ED50 ) alone or naloxone (13.3 μmol/kg) alone on infiltrative cutaneous analgesia. The preclinical data showed that naloxone is less potent than lidocaine as an infiltrative anesthetic, but its analgesic duration was longer than that of lidocaine. Furthermore, naloxone prolongs lidocaine analgesia, acting synergistically for nociceptive block.
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Affiliation(s)
- Yu-Wen Chen
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan.,Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan
| | - Ja-Ping Shieh
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.,Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Kuo-Sheng Liu
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Goerig M, Gottschalk A. [Beginning of continuous wound infusion with local anesthetics : With special emphasis on the contributions from Walter Capelle and Ewald Fulde]. Anaesthesist 2017; 66:518-529. [PMID: 28275849 DOI: 10.1007/s00101-017-0285-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Wound infusion with local anesthetics is a proven and safe analgesic procedure for modern perioperative patient care. Even the pioneers of local anesthesia practiced wound analgesia and emphasized the shortcomings of "single-shot" wound infusions. At the same time, they drew attention to the importance of long-lasting pain relief to prevent sequelae, especially after upper abdominal surgery with pneumonia, embolic events or postoperative ileus. In the early 1930s there were first sustained efforts to improve the efficiency and quality of pain therapy, especially after upper abdominal surgery by continuous wound infiltration with local anesthetics via intraoperatively introduced special cannulas. This measure was carried out to enable reduction in pain and allow early postoperative mobilization. The conceptual development of this pioneering analgesia method is closely connected with the names of the Berlin surgeons Walter Capelle and Ewald Fulde; however, their inaugurated and propagated therapy concept did not find the attention and dissemination that it deserved. This is a reason for us to remember their pioneering ideas on pain management in the context of current developments.
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Affiliation(s)
- M Goerig
- Klinik und Poliklinik für Anästhesiologie, Universitäts-Klinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Deutschland.
| | - A Gottschalk
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Diakoniekrankenhaus Friederikenstift, Hannover, Deutschland
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Dor crônica persistente pós‐operatória: o que sabemos sobre prevenção, fatores de risco e tratamento? Braz J Anesthesiol 2016; 66:505-12. [DOI: 10.1016/j.bjan.2014.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
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Kalchofner Guerrero KS, Campagna I, Bruhl-Day R, Hegamin-Younger C, Guerrero TG. Intraperitoneal bupivacaine with or without incisional bupivacaine for postoperative analgesia in dogs undergoing ovariohysterectomy. Vet Anaesth Analg 2016; 43:571-8. [DOI: 10.1111/vaa.12348] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 06/10/2015] [Indexed: 11/27/2022]
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Postoperative persistent chronic pain: what do we know about prevention, risk factors, and treatment. Braz J Anesthesiol 2016; 66:505-12. [PMID: 27591465 DOI: 10.1016/j.bjane.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 12/11/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Postoperative persistent chronic pain (POCP) is a serious health problem, disabling, undermining the quality of life of affected patients. Although more studies and research have addressed the possible mechanisms of the evolution from acute pain to chronic postoperatively, there are still no consistent data about the risk factors and prevention. This article aims to bring what is in the panorama of the current literature available. CONTENT This review describes the definition, risk factors, and mechanisms of POCD, its prevention and treatment. The main drugs and techniques are exposed comprehensively. CONCLUSION Postoperative persistent chronic pain is a complex and still unclear etiology entity, which interferes heavily in the life of the subject. Neuropathic pain resulting from surgical trauma is still the most common expression of this entity. Techniques to prevent nerve injury are recommended and should be used whenever possible. Despite efforts to understand and select risk patients, the management and prevention of this syndrome remain challenging and inappropriate.
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Cutaneous synergistic analgesia of bupivacaine in combination with dopamine in rats. Neurosci Lett 2016; 620:88-92. [DOI: 10.1016/j.neulet.2016.03.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 12/28/2015] [Accepted: 03/23/2016] [Indexed: 11/19/2022]
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Albrecht E, Guyen O, Jacot-Guillarmod A, Kirkham K. The analgesic efficacy of local infiltration analgesia vs femoral nerve block after total knee arthroplasty: a systematic review and meta-analysis. Br J Anaesth 2016; 116:597-609. [DOI: 10.1093/bja/aew099] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2016] [Indexed: 11/14/2022] Open
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Chen YW, Chiu CC, Wang JN, Hung CH, Wang JJ. Ifenprodil for prolonged spinal blockades of motor function and nociception in rats. Pharmacol Rep 2016; 68:357-62. [PMID: 26922539 DOI: 10.1016/j.pharep.2015.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/03/2015] [Accepted: 09/29/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of the study was to compare the proposed spinal anesthetic effect of ifenprodil, an a1 adrenergic receptor antagonist, with that of the long-acting local anesthetic bupivacaine. METHODS After intrathecally injecting the rats with five different doses of each drug, the dose-response curves of ifenprodil and bupivacaine were constructed to obtain the 50% effective dose (ED50). The spinal blockades of motor function and nociception of ifenprodil were compared with that of bupivacaine. RESULTS We showed that either ifenprodil or bupivacaine produced spinal blockades of motor function and nociception dose-dependently. On the ED50 basis, the potency of ifenprodil (0.42(0.38-0.46) μmol; 0.40(0.36-0.44) μmol) was equal (p>0.05) to that of bupivacaine (0.38(0.36-0.40) μmol; 0.35(0.32-0.38) μmol) in motor function and nociception, respectively. At the equianesthetic doses (ED25, ED50, and ED75), duration produced by ifenprodil was greater than that produced by bupivacaine in motor function and nociception (p<0.05 for the differences). Furthermore, both ifenprodil and bupivacaine showed longer duration of sensory blockade than that of motor blockade (p<0.05 for the differences). CONCLUSIONS The resulting data demonstrated that ifenprodil produces a dose-dependent local anesthetic effect in spinal anesthesia. Ifenprodil shows a more sensory-selective duration of action over motor block, whereas the duration of anesthesia is significantly longer with ifenprodil than with bupivacaine.
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Affiliation(s)
- Yu-Wen Chen
- Department of Physical Therapy, College of Health Care, China Medical University, Taichung, Taiwan; Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Chong-Chi Chiu
- Department of General Surgery, Chi Mei Medical Center, Tainan and Liouying, Taiwan; Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jieh-Neng Wang
- Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ching-Hsia Hung
- Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
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Clonidine intensifies memantine cutaneous analgesia in response to local skin noxious pinprick in the rat. Pharmacol Rep 2015; 67:485-9. [DOI: 10.1016/j.pharep.2014.12.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/21/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
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Abstract
Studies on enhanced recovery after gynecological surgery are limited but seem to report outcome benefits similar to those reported after colorectal surgery. Regional anesthesia is recommended in enhanced recovery protocols. Effective regional anesthetic techniques in gynecologic surgery include spinal anesthesia, epidural analgesia, transversus abdominis plane blocks, local anesthetic wound infusions and intraperitoneal instillation catheters. Non-opioid analgesics including pregabalin, gabapentin, NSAIDs, COX-2 inhibitors, and paracetamol reduce opioid consumption after surgery. This population is at high risk for PONV, thus, a multimodal anti-emetic strategy must be employed, including strategies to reduce the baseline risk of PONV in conjunction with combination antiemetic therapy.
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Affiliation(s)
- Jeanette R Bauchat
- Northwestern University, Feinberg School of Medicine, 250 East Huron Street, F5-704, Chicago, IL 60611, USA
| | - Ashraf S Habib
- Duke University Medical Center, Box 3094, Durham, NC 27710, USA.
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Tzeng JI, Pan HJ, Liu KS, Chen YW, Chen YC, Wang JJ. Epinephrine as adjuvant for propranolol produces a marked peripheral action in intensifying and prolonging analgesia in response to local dorsal cutaneous noxious pinprick in rats. Eur J Pharmacol 2014; 740:565-9. [DOI: 10.1016/j.ejphar.2014.06.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/05/2014] [Accepted: 06/06/2014] [Indexed: 02/03/2023]
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Youk EG. Preemptive analgesia in single-incision laparoscopic surgery. Ann Coloproctol 2014; 29:221-2. [PMID: 24466533 PMCID: PMC3895542 DOI: 10.3393/ac.2013.29.6.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Eui Gon Youk
- Department of Surgery, Daehang Hospital, Seoul, Korea
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Ahn SR, Kang DB, Lee C, Park WC, Lee JK. Postoperative pain relief using wound infiltration with 0.5% bupivacaine in single-incision laparoscopic surgery for an appendectomy. Ann Coloproctol 2013; 29:238-42. [PMID: 24466538 PMCID: PMC3895547 DOI: 10.3393/ac.2013.29.6.238] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 10/03/2013] [Indexed: 01/06/2023] Open
Abstract
Purpose Recently, single-incision laparoscopic surgery (SILS) has been popular for minimally invasive surgery and cosmetic improvement. However, some papers have reported that SILS for an appendectomy (SILS-A) has had the more postoperative complaints of pain. We investigated postoperative pain relief using wound infiltration with 0.5% bupivacaine in SILS-A and compared the result with that for conventional SILS-A. Methods Between July 2010 and September 2012, 75 patients who underwent SILS-A were enrolled in this study. The patients were randomly assigned to two groups: conventional SILS-A group (C-SILS-A) or wound infiltrated with 0.5% bupivacaine in SILS-A group (W-SILS-A). Forty-five patients were in the C-SILS-A, and 30 patients were in the W-SILS-A. Patients with perforated appendicitis were excluded. The clinical outcomes were compared between the groups by using the verbal numerical rating scale (VNRS). Results Clinical outcomes were similar in both study groups except for the pain score. The W-SILS-A group showed significantly lower numbers of additional pain killers and lower VNRS scores 1, 6, and 12 hours after surgery than the C-SILS-A group. Conclusion W-SILS-A is a technically simple and effective method of reducing early postoperative pain. It may be applicable in SILS-A for pain control system.
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Affiliation(s)
- So Ra Ahn
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Dong Baek Kang
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Cheol Lee
- Department of Anesthesiology, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Won Cheol Park
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
| | - Jeong Kyun Lee
- Department of Surgery, Digestive Disease Research Institute and Institute of Medical Science, Wonkwang University College of Medicine, Iksan, Korea
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Cutaneous Analgesia and Systemic Toxicity of Carbetapentane and Caramiphen in Rats. Reg Anesth Pain Med 2012; 37:34-9. [DOI: 10.1097/aap.0b013e318237f6ab] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kessous R, Wiznitzer A, Polachek H, Weintraub AY, Zlotnik A, Pariente G, Aricha-Tamir B, Press F, Leizerovich A, Sheiner E. Preoperative analgesia with local lidocaine infiltration for post cesarean delivery pain management. J Matern Fetal Neonatal Med 2011; 25:1131-4. [DOI: 10.3109/14767058.2011.624222] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee JB, Choi SS, Ahn EH, Hahm KD, Suh JH, Leem JG, Shin JW. Effect of perioperative perineural injection of dexamethasone and bupivacaine on a rat spared nerve injury model. Korean J Pain 2010; 23:166-71. [PMID: 20830261 PMCID: PMC2935977 DOI: 10.3344/kjp.2010.23.3.166] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Revised: 07/29/2010] [Accepted: 08/02/2010] [Indexed: 11/18/2022] Open
Abstract
Background Neuropathic pain resulting from diverse causes is a chronic condition for which effective treatment is lacking. The goal of this study was to test whether dexamethasone exerts a preemptive analgesic effect with bupivacaine when injected perineurally in the spared nerve injury model. Methods Fifty rats were randomly divided into five groups. Group 1 (control) was ligated but received no drugs. Group 2 was perineurally infiltrated (tibial and common peroneal nerves) with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 3 was infiltrated with 0.4% bupivacaine (0.2 ml) and dexamethasone (0.8 mg) after surgery. Group 4 was infiltrated with normal saline (0.2 ml) and dexamethasone (0.8 mg) 10 minutes before surgery. Group 5 was infiltrated with only 0.4% bupivacaine (0.2 ml) before surgery. Rat paw withdrawal thresholds were measured using the von Frey hair test before surgery as a baseline measurement and on postoperative days 3, 6, 9, 12, 15, 18 and 21. Results In the group injected preoperatively with dexamethasone and bupivacaine, mechanical allodynia did not develop and mechanical threshold forces were significantly different compared with other groups, especially between postoperative days 3 and 9 (P < 0.05). Conclusions In conclusion, preoperative infiltration of both dexamethasone and bupivacaine showed a significantly better analgesic effect than did infiltration of bupivacaine or dexamethasone alone in the spared nerve injury model, especially early on after surgery.
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Affiliation(s)
- Jeong Beom Lee
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Fitzpatrick CL, Weir HL, Monnet E. Effects of infiltration of the incision site with bupivacaine on postoperative pain and incisional healing in dogs undergoing ovariohysterectomy. J Am Vet Med Assoc 2010; 237:395-401. [DOI: 10.2460/javma.237.4.395] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Elder JB, Hoh DJ, Liu CY, Wang MY. Postoperative continuous paravertebral anesthetic infusion for pain control in posterior cervical spine surgery: a case-control study. Neurosurgery 2010; 66:99-106; discussion 106-7. [PMID: 20173578 DOI: 10.1227/01.neu.0000349208.87863.b3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients who undergo posterior cervical spinal fusion procedures frequently experience significant postoperative pain. Use of a local anesthetic continuous infusion pump after surgery may improve these outcome variables. METHODS After posterior cervical spine fusion procedures, 25 consecutive patients received continuous infusion of 0.5% bupivacaine into the subfascial aspects of the wound via an elastomeric pump. Data were collected prospectively by third party assessment using standard nursing protocols. This included numeric pain scores and opiate use over the first 4 postoperative days (PODs), length of hospitalization, and complications. In a retrospective analysis, we compared each study patient to a control patient who did not receive the continuous infusion of bupivacaine. Demographic variables and surgical procedure were similar among matched cases. RESULTS Patients receiving continuous local anesthetic infusion used significantly less narcotics (P < .05) during the first 4 PODs: 24.4% on day 1, 34.1% on day 2, 53.5% on day 3, and 58.1% on day 4. A lower average pain score was observed among study patients on each POD (P < .05): 31.5% less on day 1, 13.0% on day 2, 24.0% on day 3, and 35.7% on day 4. Patients with the infusion device were discharged home earlier (POD 4.9 versus 6.7; P = .024) and demonstrated improvement in time to ambulation, first bowel movement, and discontinuation of the patient-controlled analgesia machine. No complications were associated with the device. CONCLUSION Patients with the local anesthetic continuous infusion device required less narcotics and reported lower pain scores than control patients on each of the first 4 PODs. These results suggest that continuous infusion of local anesthetic into the paravertebral tissue during the immediate postoperative period is a safe and effective technique that achieves lower pain scores and narcotic use and improves multiple postoperative outcome variables.
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Affiliation(s)
- James B Elder
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
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Hung CH, Liu KS, Shao DZ, Cheng KI, Chen YC, Chen YW. The Systemic Toxicity of Equipotent Proxymetacaine, Oxybuprocaine, and Bupivacaine During Continuous Intravenous Infusion in Rats. Anesth Analg 2010; 110:238-42. [DOI: 10.1213/ane.0b013e3181bf6acf] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Gómez Ríos MA, Vázquez Barreiro L, Nieto Serradilla L, Diz Gómez JC, López Alvarez S. [Efficacy of a continuous infusion of local anesthetic into the surgical wound for pain relief after abdominal hysterectomy]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2009; 56:417-424. [PMID: 19856688 DOI: 10.1016/s0034-9356(09)70422-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To assess the quality of postoperative analgesia provided by intravenous administration of paracetamol and ketorolac plus morphine in bolus doses with or without continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. Patient satisfaction was included among the outcomes assessed. MATERIAL AND METHODS Prospective pilot study in ASA 1-2 patients randomized to 2 groups: women in the subcutaneous catheter group received intravenous analgesics plus a continuous infusion (2 mL/h) of 0.25% bupivacaine whereas women in the control group received only the intravenous analgesics. The outcome measures were pain intensity assessed on a verbal numerical scale at rest and with movement, morphine requirements in the first 48 hours after surgery, and complications related to the drugs used or the technique. RESULTS Twenty-six patients were enrolled; 10 were randomized to the catheter group and 16 to the control group. Statistically significant between-group differences in pain both at rest and with movement were found while the women were in the postoperative recovery unit. Postoperative pain with movement was also significantly different at 24 hours (P<.004) and 48 hours (P<.02). Similarly, mean (SD) morphine requirements in the recovery unit were significantly greater in the control group, at 8 (2.27) mg, compared with 3.20 (1.79) mg in the catheter group (P<.002). Walking began earlier in the catheter group. No differences were found in the incidences of complications. CONCLUSIONS Postoperative pain is effectively relieved by continuous infusion of local anesthetic into the surgical wound after abdominal hysterectomy. This technique provides good analgesia with less morphine consumption and scarce adverse effects. Patient satisfaction and the sense of receiving quality pain management are high.
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Affiliation(s)
- M A Gómez Ríos
- Servicio de Anestesiología y Reanimación, 1Complexo Hospitalario Universitario A Coruña, Coruña.
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Dere K, Sen H, Teksoz E, Ozkan S, Dagli G, Sucullu I, Filiz AI, Ipcioglu OM, Kucukodaci Z. The Comparison of the Effects of Different Doses of Levobupivacaine Infiltration on Wound Healing. J INVEST SURG 2009; 22:112-6. [DOI: 10.1080/08941930802713019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Relief of postoperative pain by local anaesthetic infiltration: Efficacy for major abdominal and orthopedic surgery. Pain 2009; 143:7-11. [DOI: 10.1016/j.pain.2009.02.020] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2009] [Accepted: 02/20/2009] [Indexed: 11/21/2022]
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Intraabdominal local anaesthetics for postoperative pain relief following abdominal hysterectomy: a randomized, double-blind, dose-finding study. Eur J Anaesthesiol 2009; 26:421-9. [DOI: 10.1097/eja.0b013e3283261b53] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G. Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. Br J Anaesth 2008; 101:841-7. [PMID: 19004914 DOI: 10.1093/bja/aen309] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Block of parietal nociceptive afferent nerves using continuous wound infiltration with local anaesthetics may be beneficial in multimodal postoperative pain management. The effectiveness of continuous wound infusion of ropivacaine for postoperative pain relief after open nephrectomy was analysed in a prospective, randomized, double-blinded, placebo-controlled trial. METHODS One hundred and sixty-eight patients were randomized to either 0.5% ropivacaine (ON-Q group) or 0.9% NaCl (control group), using an elastomeric pump which delivered 4 ml h(-1) over 48 h through two multiholed Soaker catheters placed between the transverse and the internal oblique muscles and the s.c. space. All patients received a standard postoperative pain management protocol, including patient-controlled analgesic morphine and ketorolac. Outcomes measured over 48 h after operation were visual analogue scale (VAS) and incident (i) VAS pain scores, morphine consumption, and side-effects; time to bowel function recovery; and mean length of hospitalization. RESULTS Side-effects were similar between the two groups. VAS and i-VAS pain scores, morphine consumption [11.5 (0.27) vs 21.8 (0.37) mg; P<0.001], time to bowel recovery [21.8 (0.4) vs 33.6 (0.9) h; P<0.001], and mean length of hospitalization [2.1 (0.03) vs 3.2 (0.1) days; P<0.001] were significantly reduced in the ON-Q group. Cost analysis revealed an overall savings of approximately 273 euros per patient in the ON-Q group. CONCLUSIONS Continuous surgical wound infusion with ropivacaine improved pain relief and accelerated recovery and discharge reducing overall costs of care.
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Affiliation(s)
- E Forastiere
- Department of Anesthesiology, Regina Elena' National Cancer Institute of Rome, Via Elio Chianesi 53, Italy
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Long JB, Eiland RJ, Hentz JG, Mergens PA, Magtibay PM, Kho RMC, Magrina JF, Cornella JL. Randomized trial of preemptive local analgesia in vaginal surgery. Int Urogynecol J 2008; 20:5-10. [PMID: 18830553 DOI: 10.1007/s00192-008-0716-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Accepted: 08/17/2008] [Indexed: 11/25/2022]
Abstract
Preemptive analgesia in vaginal surgery has had conflicting efficacy reported in the existing literature. This study was designed to clarify the usefulness of preemptive local analgesia (PLA) in patients undergoing vaginal hysterectomy. A prospective, randomized, double-blinded trial of PLA in 90 women undergoing vaginal hysterectomy was conducted. PLA consisted of 20 ml of 0.5% bupivacaine with 1:200,000 epinephrine injected in a paracervical-type fashion. Total narcotic use and pain (using a visual analog scale (VAS)) was recorded at 30 min, 3, 12, and 24 h postoperatively. The mean total dose of narcotic was significantly less in the PLA group versus the placebo group (P = 0.009) at every time point postoperatively. Additionally, the mean pain VAS 30 min and 3 h postoperatively was 43% (P = 0.003) and 33% (P = 0.02) lower, respectively, in the PLA group. PLA with bupivacaine prior to vaginal hysterectomy is associated with significantly lower pain scores and a reduction in narcotic use postoperatively.
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Affiliation(s)
- Jaime B Long
- Department of Gynecologic Surgery, Mayo Clinic, Scottsdale, AZ, USA
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Infiltration of the sternotomy wound and the mediastinal tube sites with 0.25% levobupivacaine as adjunctive treatment for postoperative pain after cardiac surgery*. Eur J Anaesthesiol 2008; 25:842-9. [DOI: 10.1017/s0265021508004614] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Savvas I, Papazoglou LG, Kazakos G, Anagnostou T, Tsioli V, Raptopoulos D. Incisional Block With Bupivacaine for Analgesia After Celiotomy in Dogs. J Am Anim Hosp Assoc 2008; 44:60-6. [DOI: 10.5326/0440060] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A blind, placebo-controlled clinical trial was performed to evaluate the postoperative analgesic effect of preoperative infiltration of the incision site with bupivacaine in dogs undergoing celiotomy. Sixty dogs were randomly allocated into four groups: preoperative bupivacaine, postoperative bupivacaine, preoperative saline, and postoperative saline. All dogs were premedicated with acepromazine and meperidine; then they were anesthetized with thiopentone and isoflurane. Each group received either bupivacaine or normal saline before midline incision or just before skin closure. After surgery, pain scores were assigned using a numerical rating scale. Preoperative bupivacaine was associated with significantly lower pain scores and a significantly lower need for opioid administration. The authors conclude that a preoperative incisional block with bupivacaine seems to be a useful adjunct for controlling pain after celiotomy in dogs.
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Affiliation(s)
- Ioannis Savvas
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
| | - Lysimachos G. Papazoglou
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
| | - George Kazakos
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
| | - Tilemahos Anagnostou
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
| | - Vassiliki Tsioli
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
| | - Dimitris Raptopoulos
- Companion Animal Clinic, Department of Clinical Sciences, Faculty of Veterinary Medicine, Aristotle University of Thessaloniki, 11 S. Voutyra Street, 54627, Thessaloniki, Greece
- From the
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Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine (Phila Pa 1976) 2008; 33:210-8. [PMID: 18197109 DOI: 10.1097/brs.0b013e318160447a] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective, case-control study was conducted to analyze postoperative outcomes in patients who received local anesthetic infusion pumps after lumbar spinal fusion procedures. Data were collected prospectively via nursing protocol and third party assessment, and analyzed retrospectively. OBJECTIVE To review the safety and efficacy of continuous infusion of local anesthetic into the subfascial aspects of the wound after lumbar fusion surgery for treatment of postoperative pain, and to determine whether other outcome measures such as postoperative nausea and vomiting, ambulation and length of hospitalization were affected by the presence of the device. SUMMARY OF BACKGROUND DATA Patients who undergo lumbar spine fusion procedures frequently experience significant, debilitating pain related to their surgery. This pain may delay postoperative mobilization, increase length of hospitalization, and require prolonged use of high doses of narcotics. Use of a local anesthetic continuous-infusion pump after surgery may lead to improvements in these outcome variables. METHODS After posterior lumbar spine fusion procedures, 26 consecutive patients received the ON-Q PainBuster, which infused 0.5% marcaine via an elastomeric pump into the subfascial aspects of the wound. Retrospective analysis compared each of these patients with a case-matched control patient. Data included pain scores and opiate use during the first 5 postoperative days (PODs), length of hospital stay, and complications. Variables such as age, American Society of Anesthesiologists (ASA) physical status, and surgical procedure were similar between matched cases. One patient was excluded because of active heroine abuse. RESULTS Patients with the ON-Q PainBuster used 41.2% less narcotics on POD 1, 50.1% less on day 2, and 47.1% less on day 3 compared with the control patients. Differences in opiate usage were not statistically significant on POD 4 (45.5% less) and 5 (50.3% less). A lower average pain score was observed among patients with the ON-Q PainBuster on each POD: 39.1% less pain on POD 1, 34.0% on day 2, 45.1% on day 3, 29.5% on day 4, and 43.6% on day 5. No differences were observed in length of hospital stay or complication rate. CONCLUSION Patients who received the ON-Q PainBuster used less narcotic medications than case-matched patients during the first 3 PODs, and reported lower pain scores during the first 5 PODs. No complications attributable to the device were noted. These results suggest that continuous infusion of local anesthetic into the wound during the immediate postoperative period is a safe and effective technique that results in lower pain scores and narcotic use. Further data may reveal additional benefits such as lower incidence of nausea and vomiting and decreased times to mobility and functional independence.
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Lowenstein L, Zimmer EZ, Deutsch M, Paz Y, Yaniv D, Jakobi P. Preoperative analgesia with local lidocaine infiltration for abdominal hysterectomy pain management. Eur J Obstet Gynecol Reprod Biol 2006; 136:239-42. [PMID: 17178187 DOI: 10.1016/j.ejogrb.2006.11.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 11/14/2006] [Accepted: 11/20/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the impact of preemptive local analgesia at the incision site in reducing pain in women undergoing abdominal hysterectomy for a benign myomatous uterus. STUDY DESIGN In this prospective, randomized, double-blinded, placebo-controlled study, 20 mL of 1% lidocaine or 0.9% saline was injected at the abdominal incision site prior to the performance of the hysterectomy. Thirty-two women were enrolled in the study, 16 received preemptive analgesia while 14 were treated by placebo; 2 were excluded. All operations were performed under general anesthesia. The standard postoperative pain treatment consisted of oral analgesia with ibuprofen (400 mg) in liquid-filled capsules. Morphine (10 mg) was used for rescue analgesia. Pain intensity was self-evaluated with the use of a 100 mm visual analog scale. RESULTS Compared to the placebo group, women who received preemptive analgesia with lidocaine 1% perceived a significant reduction in postoperative pain in the first hours after surgery (2 h: 50.1+/-27.9 versus 70.6+/-22.6, p=0.043; 5 h: 42.5+/-25.2 versus 64.6+/-28.3, p=0.043; 8 h: 31.2+/-22.4 versus 53.3+/-30.3, p=0.031). CONCLUSION Preemptive analgesia with lidocaine 1% is a simple, cheap and efficient mode to reduce pain in the first hours after hysterectomy.
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Affiliation(s)
- Lior Lowenstein
- Department of Obstetrics and Gynecology, Rambam Medical Center, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Herbland A, Cantini O, Reynier P, Valat P, Jougon J, Arimone Y, Janvier G. The Bilateral Superficial Cervical Plexus Block With 0.75% Ropivacaine Administered Before or After Surgery Does Not Prevent Postoperative Pain After Total Thyroidectomy. Reg Anesth Pain Med 2006. [DOI: 10.1097/00115550-200601000-00007] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Levy BS, Luciano DE, Emery LL. Outpatient vaginal hysterectomy is safe for patients and reduces institutional cost. J Minim Invasive Gynecol 2005; 12:494-501. [PMID: 16337576 DOI: 10.1016/j.jmig.2005.06.015] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2005] [Accepted: 07/11/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate a management protocol based on scientific evidence in the care of patients undergoing vaginal hysterectomy. STUDY DESIGN (Canadian Task Force classification II-2). SETTING 110-bed community hospital. PATIENTS Women with vaginal hysterectomy between 2000 and 2003. INTERVENTION Data were collected on all vaginal hysterectomies performed by a single surgeon over a 4-year period. Demographics, surgical indications, procedural parameters, length of stay, and postoperative complications were evaluated. Hospital costs for all vaginal hysterectomies performed over a 2-year period at the same hospital also were examined. An analysis of the literature was performed to develop a protocol for optimizing patients' surgical experience. All patients were managed using the protocol. These patients were compared with a cohort at the same institution. MEASUREMENTS AND MAIN RESULTS Four hundred twelve vaginal hysterectomies were performed by the lead author during the 4-year time period. Three hundred eighty-four patients (93%) were discharged within 12 hours of admission. There were no readmissions for bleeding, pain management, urinary retention, or nausea and vomiting. Four hundred nineteen vaginal hysterectomies were performed by 10 surgeons from 2002 through 2003 at the same institution, including 219 by the lead author. The average direct cost for outpatient vaginal hysterectomy was 21.3% lower than for inpatient vaginal hysterectomy. CONCLUSION Incorporating a protocol based on scientific evidence into the management of surgical patients facilitated safe outpatient vaginal hysterectomy in a majority of patients. This optimized management may save up to 25% of the cost for these procedures.
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Affiliation(s)
- Barbara S Levy
- Women's Health Center, St. Francis Hospital, Federal Way, Washington 98003, and University of Colorado Health Sciences Center, Denver, USA.
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Karamanlioglu B, Turan A, Memis D, Kaya G, Ozata S, Ture M. Infiltration with ropivacaine plus lornoxicam reduces postoperative pain and opioid consumption. Can J Anaesth 2005; 52:1047-53. [PMID: 16326674 DOI: 10.1007/bf03021603] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To compare efficacy and patient outcome of wound infiltration with ropivacaine, lornoxicam, or their combination for control of pain following thyroid surgery. METHODS Eighty patients underwent thyroid surgery were randomly assigned to one of four groups. Before skin closure, local tissues were infiltrated with 12 mL saline in Group S, with 10 mL of ropivacaine 0.75% plus 2 mL saline in Group R, with 2 mL of lornoxicam (8 mg) plus 10 mL saline in Group L, and with 10 mL ropivacaine 0.75% plus 2 mL lornoxicam (8 mg) in Group RL. Pain scores, total and incremental meperidine con-eight, 12, 18, and 24 hr postoperatively. Time to first analgesic requirement, patient satisfaction, and duration of hospital stay were also compared after surgery. RESULTS The pain scores in Group RL were significantly lower in the first 12 hr than in Group S, and in the first four hours than in Groups R and L (P < 0.01). The time to first analgesic requirement was significantly longer (14.8 +/- 8.4 hr vs 5.9 +/- 5.2 hr; P < 0.01), the total pethidine consumption was significantly less than Group S (34.0 +/- 33.0 mg vs 78.0 +/- 29.8 mg; P<0.001), return of gastrointestinal function, ambulation time, length of hospital stay (P < 0.05) were significantly shorter, and patient satisfaction (P < 0.01) was significantly better in Group RL than in Group S (P < 0.05). CONCLUSION Wound infiltration with ropivacaine 0.75% plus lornoxicam 8 mg combination improved postoperative pain control and patient comfort, and decreased the need for opioids than the use of either drug alone.
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Affiliation(s)
- Beyhan Karamanlioglu
- Department of Anesthesiology, Trakya Universiy, Medical Faculty, Edirne, Turkey.
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Intraoperative wound instillation of ropivacaine extraperitoneally subfascially fails to provide analgesia after remifentanil–isoflurane for abdominal hysterectomy. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.acpain.2005.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Lu L, Fine NA. The Efficacy of Continuous Local Anesthetic Infiltration in Breast Surgery: Reduction Mammaplasty and Reconstruction. Plast Reconstr Surg 2005; 115:1927-34; discussion 1935-6. [PMID: 15923838 DOI: 10.1097/01.prs.0000163332.04220.bd] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Pain control after reduction mammaplasty and breast reconstruction with tissue expanders often requires intravenous narcotic analgesia and inpatient hospitalization. Regional and local anesthetic techniques are increasing in popularity because they decrease the use of intravenous analgesic medications and offer comparable pain relief without the systemic side effects. METHODS This study examined the use of indwelling catheters for the continuous infiltration of local anesthetic (bupivacaine) in 74 consecutive breast reduction and 74 consecutive tissue expander breast reconstruction patients. Patients entering the study before February of 2003 had conventional methods of analgesia (39 patients for each group), whereas those entering afterwards received the infusion pumps (35 patients for each group). RESULTS The number of hospital admissions among the breast reduction patients with infusion pumps was significantly less than that for those without pumps (p < 0.01). Pain, measured on a verbal response scale of 0 to 10, while in the recovery room was significantly less in the pain pump group than in the comparison group (p < 0.01), as were cumulative amounts of pain medications (p < 0.01). There were no statistically significant differences in the number of complications or in the rate of nausea or vomiting. The number of inpatient days among the tissue expander reconstruction patients with infusion pumps was not significantly different from that for those without pumps; the average pain score was significantly lower (p < 0.01). The cumulative amounts of pain medication in patients receiving the infusion pump were significantly lower than those in patients without the pumps (p < 0.01). There were no statistically significant differences in the number of complications or in the rate of nausea or vomiting. There were no tissue expander infections in patients with the indwelling catheters adjacent to the implant. CONCLUSIONS The continuous infiltration of local anesthetic with an infusion pump represents another tool for pain management in surgical patients.
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Affiliation(s)
- Leonard Lu
- Department of Plastic Surgery, Northwestern Memorial Hospital, Chicago, Ill, USA
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Lohsiriwat V, Lert-akyamanee N, Rushatamukayanunt W. Efficacy of pre-incisional bupivacaine infiltration on postoperative pain relief after appendectomy: prospective double-blind randomized trial. World J Surg 2004; 28:947-50. [PMID: 15573244 DOI: 10.1007/s00268-004-7471-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Pain is the most undesirable and threatening experience for surgical patients. This study aims to determine the efficacy of pre-incisional analgesic bupivacaine infiltration (preemptive analgesia) on postoperative pain relief after appendectomy. A prospective randomized double-blinded study was conducted on 123 patients aged 13-45 years with a preoperative and-postoperative diagnosis of acute appendicitis admitted to Siriraj Hospital, Bangkok, from January to May 2002. They were randomly set into two groups: the control (61 patients) and the preemptive (62 patients). In the preemptive group, bupivacaine (Marcaine) was infiltrated into the skin and subcutaneous tissue along the proposed wound line before gridiron incision, and also into the muscle layer after incision. The control group received no injection. Routine appendectomy was done. Pain score was assessed by the patients in the first 48 hr while they were lying supine and as they moved to a sitting position at 24 and 48 hr after operation. Morphine injection was given on patients' request with pain score = 5 every 4 hr in the first 48 hr or until analgesic paracetamol could be taken orally. The pain score during the first 6, 12, 24, and 48 hr, including the score while sitting up, were all significantly lower ( p < 0.001) in the preemptive group. So were the total number of morphine injections and the amount of morphine used postoperatively. The pain reduction could be due to interruption of inflammatory or pain mediator cascades that normally occur during an operation. This study showed that pre-incisional bupivacaine infiltration is an effective and simple method of reducing postoperative pain for patients undergoing appendectomy.
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Affiliation(s)
- Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, 10700, Bangkok, Thailand.
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Lam KW, Pun TC, Ng EHY, Wong KS. Efficacy of preemptive analgesia for wound pain after laparoscopic operations in infertile women: a randomised, double-blind and placebo control study. BJOG 2004; 111:340-4. [PMID: 15008770 DOI: 10.1111/j.1471-0528.2004.00083.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare preemptive analgesia and preclosure analgesia in reducing wound pain after laparoscopic operation. DESIGN Randomised, double-blind and placebo control. SETTING University referral centre. POPULATION Infertile women undergoing diagnostic laparoscopy with or without additional procedures. METHODS One hundred and forty-four women were randomised to receive 10 mL of 1% lignocaine at the surgical sites before incision and 10 mL of normal saline before closure of incision (the preemptive group), saline before incision and lignocaine before closure of incision (the preclosure group) and saline at the surgical sites both before incision and closure of incision (the placebo group). MAIN OUTCOME MEASURES Post-operative wound pain measured by linear visual analogue scale and amount of analgesic use. RESULTS The women in the preclosure group had significantly lower pain scores at 2, 4 and 24 hours than those in the placebo group, whereas the women in the preemptive group only showed significantly lower pain scores at 2 hours than the placebo group. The pain score at 24 hours in the preclosure group was significantly lower than that in the preemptive group. There was no significant difference in the post-operative analgesic requirement among the three groups. CONCLUSION The preclosure analgesia is better than preemptive analgesia and no analgesia in reducing post-operative wound pain.
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Affiliation(s)
- K W Lam
- Department of Obstetrics and Gynaecology, The University of Hong Kong, Hong Kong
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Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, Guberti A, Massari L. The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery. Anesth Analg 2004; 98:166-172. [PMID: 14693613 DOI: 10.1213/01.ane.0000093310.47375.44] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED Because local anesthetic continuous wound instillation has not been evaluated after spine fusion surgery, we designed this study to determine whether this technique could enhance analgesia and improve patient outcome after posterior lumbar arthrodesis. Thirty-eight patients undergoing spine stabilization were randomly divided into two groups. The M group received a postoperative baseline IV infusion of morphine plus ketorolac for 24 h, and the R group received IV saline. In both groups, a multihole 16-gauge catheter was placed subcutaneously; in the R group, the wound was infiltrated with a solution of ropivacaine 0.5% 200 mg/40 mL, and infusion of ropivacaine 0.2% 5 mL/h was maintained for 55 h. In the M group, saline infusion was given at the same rate. Pain scores were taken at rest and on passive mobilization by nurses blinded to patient analgesic treatment. The total plasma ropivacaine concentration was evaluated. Pain scores and rescue medication requirements (diclofenac and tramadol) were significantly less in the R group than in the M group. Postoperative blood loss was less and the length of hospital stay was shorter in the R group. The ropivacaine peak total plasma concentration occurred at 24 h during infusion and was within safe limits; no toxic local anesthetic side effects were observed. These results suggest that wound infiltration and continuous instillation of ropivacaine 0.2% is effective for pain management after spine stabilization surgery. IMPLICATIONS Postoperative pain after lumbar arthrodesis is related to soft tissue and muscle dissection and to manipulations and removal at the operation site. By blocking noxious stimuli from the surgical area, infiltration and wound perfusion with ropivacaine were more effective in controlling pain than systemic analgesia.
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Affiliation(s)
- Margherita Bianconi
- Departments of *Anesthesiology and Intensive Care and §Clinical Pharmacology, St. Anna Hospital, Ferrara, Italy; and Departments of †Clinical and Experimental Medicine, Section of Pharmacology, and ‡Biomedical Sciences and Advanced Therapies, Section of Orthopaedics and Traumatology, University of Ferrara, Ferrara, Italy
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Bianconi M, Ferraro L, Traina GC, Zanoli G, Antonelli T, Guberti A, Ricci R, Massari L. Pharmacokinetics and efficacy of ropivacaine continuous wound instillation after joint replacement surgery † †Declaration of interest. This work was supported by AstraZeneca, Basiglio, Milano, Italy. Presented in part at the Third European Congress of Orthopaedic Anaesthesia, 31 May–2 June 2001, London, UK. Br J Anaesth 2003; 91:830-5. [PMID: 14633754 DOI: 10.1093/bja/aeg277] [Citation(s) in RCA: 156] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND As continuous wound instillation with local anaesthetic has not been evaluated after hip/knee arthroplasties, our study was designed to determine whether this technique could enhance analgesia and improve patient outcome after joint replacement surgery. METHODS Thirty-seven patients undergoing elective hip/knee arthroplasties under spinal block were randomly assigned to two analgesia groups. Group M received continuous i.v. infusion of morphine plus ketorolac for 24 h. Then, a multi-hole 16 G catheter was placed subcutaneously and infusion of saline was maintained for 55 h. Group R received i.v. saline. Thereafter the wound was infiltrated with a solution of ropivacaine 0.5% 40 ml, then a multi-hole 16 G catheter was placed subcutaneously and an infusion of ropivacaine 0.2% 5 ml h(-1) was maintained for 55 h. Visual analogue scale scores were assessed at rest and on passive mobilization by nurses blinded to analgesic treatment. Total plasma ropivacaine concentration was measured. RESULTS Group R showed a significant reduction in postoperative pain at rest and on mobilization, while rescue medication requirements were greater in Group M. Total ropivacaine plasma concentration remained below toxic concentrations and no adverse effects occurred. Length of hospital stay was shorter in Group R. CONCLUSION Infiltration and wound instillation with ropivacaine 0.2% is more effective in controlling postoperative pain than systemic analgesia after major joint replacement surgery.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Amides/administration & dosage
- Amides/blood
- Analgesics, Opioid/administration & dosage
- Anesthetics, Local/administration & dosage
- Anesthetics, Local/blood
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Drug Administration Schedule
- Drug Combinations
- Female
- Humans
- Infusions, Intralesional
- Ketorolac/administration & dosage
- Length of Stay
- Male
- Middle Aged
- Morphine/administration & dosage
- Pain Measurement
- Pain, Postoperative/blood
- Pain, Postoperative/drug therapy
- Patient Satisfaction
- Ropivacaine
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Affiliation(s)
- M Bianconi
- Department of Anesthesiology and Intensive Care, St Anna Hospital Ferrara, Ferrara, Italy
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Pacik PT, Werner C, Jackson N, Lobsitz C. Pain control in augmentation mammaplasty: the use of indwelling catheters in 200 consecutive patients. Plast Reconstr Surg 2003; 111:2090-6; discussion 2097-8. [PMID: 12711975 DOI: 10.1097/01.prs.0000057146.92565.e3] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Peter T Pacik
- Plastic Surgery Professional Association, Manchester, NH 02104, USA.
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Postincisional local anaesthetic infiltration of the rectus muscle decreases early pain and morphine consumption after abdominal hysterectomy. ACTA ACUST UNITED AC 2002. [DOI: 10.1016/s1366-0071(02)00022-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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