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Published in: Surgical Endoscopy 2/2021

01-02-2021 | Laparoscopy

Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial

Authors: Nae Hyun Lee, Kyoungho Ryu, Taejong Song

Published in: Surgical Endoscopy | Issue 2/2021

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Abstract

Background

To investigate the efficacy of continuous wound infusion (CWI) with local anesthetics for reducing postoperative pain compared with placebo in patients undergoing benign gynecologic laparoscopy.

Methods

In this double-blind trial, 66 patients were randomly assigned to receive either ropivacaine or normal saline though a multi-orifice catheter placed into the umbilical surgical wound for 50 h postoperatively. The primary outcome measure was the severity of postoperative pain 1, 6, 12, 24, and 48 h after surgery. The secondary outcome measure was the number of rescue analgesics requested.

Results

Baseline characteristics did not statistically differ between the ropivacaine and placebo groups. The intensity of postoperative pain was significantly lower in the ropivacaine group than in the placebo group 1, 6, 12, 24, and 48 h after surgery (all P < 0.05). The number of rescue analgesics requested was also significantly lower in the ropivacaine group than in the placebo group. There were no significant differences between the two groups regarding other surgical outcomes.

Conclusion

CWI with local anesthetics after laparoscopic surgery provides good analgesia and reduces rescue analgesics consumption.
Literature
1.
go back to reference Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C (2014) Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev:CD004638 Bhave Chittawar P, Franik S, Pouwer AW, Farquhar C (2014) Minimally invasive surgical techniques versus open myomectomy for uterine fibroids. Cochrane Database Syst Rev:CD004638
2.
go back to reference Medeiros LR, Stein AT, Fachel J, Garry R, Furness S (2008) Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer 18:387–399CrossRef Medeiros LR, Stein AT, Fachel J, Garry R, Furness S (2008) Laparoscopy versus laparotomy for benign ovarian tumor: a systematic review and meta-analysis. Int J Gynecol Cancer 18:387–399CrossRef
3.
go back to reference Trowbridge ER, Dreisbach CN, Sarosiek BM, Dunbar CP, Evans SL, Hahn LA, Hullfish KL (2018) Review of enhanced recovery programs in benign gynecologic surgery. Int Urogynecol J 29:3–11CrossRef Trowbridge ER, Dreisbach CN, Sarosiek BM, Dunbar CP, Evans SL, Hahn LA, Hullfish KL (2018) Review of enhanced recovery programs in benign gynecologic surgery. Int Urogynecol J 29:3–11CrossRef
4.
go back to reference Fredman B, Shapiro A, Zohar E, Feldman E, Shorer S, Rawal N, Jedeikin R (2000) The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg 91:1436–1440CrossRef Fredman B, Shapiro A, Zohar E, Feldman E, Shorer S, Rawal N, Jedeikin R (2000) The analgesic efficacy of patient-controlled ropivacaine instillation after Cesarean delivery. Anesth Analg 91:1436–1440CrossRef
5.
go back to reference Givens VA, Lipscomb GH, Meyer NL (2002) A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 186:1188–1191CrossRef Givens VA, Lipscomb GH, Meyer NL (2002) A randomized trial of postoperative wound irrigation with local anesthetic for pain after cesarean delivery. Am J Obstet Gynecol 186:1188–1191CrossRef
6.
go back to reference Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawal N (2004) Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg 99:1173–1179, table of contents Gupta A, Perniola A, Axelsson K, Thorn SE, Crafoord K, Rawal N (2004) Postoperative pain after abdominal hysterectomy: a double-blind comparison between placebo and local anesthetic infused intraperitoneally. Anesth Analg 99:1173–1179, table of contents
7.
go back to reference Kristensen BB, Christensen DS, Ostergaard M, Skjelsager K, Nielsen D, Mogensen TS (1999) Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine. Reg Anesth Pain Med 24:576–580CrossRef Kristensen BB, Christensen DS, Ostergaard M, Skjelsager K, Nielsen D, Mogensen TS (1999) Lack of postoperative pain relief after hysterectomy using preperitoneally administered bupivacaine. Reg Anesth Pain Med 24:576–580CrossRef
8.
go back to reference Kushner DM, LaGalbo R, Connor JP, Chappell R, Stewart SL, Hartenbach EM (2005) Use of a bupivacaine continuous wound infusion system in gynecologic oncology: a randomized trial. Obstet Gynecol 106:227–233CrossRef Kushner DM, LaGalbo R, Connor JP, Chappell R, Stewart SL, Hartenbach EM (2005) Use of a bupivacaine continuous wound infusion system in gynecologic oncology: a randomized trial. Obstet Gynecol 106:227–233CrossRef
9.
go back to reference Leong WM, Lo WK, Chiu JW (2002) Analgesic efficacy of continuous delivery of bupivacaine by an elastomeric balloon infusor after abdominal hysterectomy: a prospective randomised controlled trial. Aust N Z J Obstet Gynaecol 42:515–518CrossRef Leong WM, Lo WK, Chiu JW (2002) Analgesic efficacy of continuous delivery of bupivacaine by an elastomeric balloon infusor after abdominal hysterectomy: a prospective randomised controlled trial. Aust N Z J Obstet Gynaecol 42:515–518CrossRef
10.
go back to reference Mecklem DW, Humphrey MD, Hicks RW (1995) Efficacy of bupivacaine delivered by wound catheter for post-Caesarean section analgesia. Aust N Z J Obstet Gynaecol 35:416–421CrossRef Mecklem DW, Humphrey MD, Hicks RW (1995) Efficacy of bupivacaine delivered by wound catheter for post-Caesarean section analgesia. Aust N Z J Obstet Gynaecol 35:416–421CrossRef
11.
go back to reference Zohar E, Fredman B, Phillipov A, Jedeikin R, Shapiro A (2001) The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy. Anesth Analg 93:482–487, 484th contents page Zohar E, Fredman B, Phillipov A, Jedeikin R, Shapiro A (2001) The analgesic efficacy of patient-controlled bupivacaine wound instillation after total abdominal hysterectomy with bilateral salpingo-oophorectomy. Anesth Analg 93:482–487, 484th contents page
12.
go back to reference Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G (2008) 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 101:841–847CrossRef Forastiere E, Sofra M, Giannarelli D, Fabrizi L, Simone G (2008) 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 101:841–847CrossRef
13.
go back to reference Karthikesalingam A, Walsh SR, Markar SR, Sadat U, Tang TY, Malata CM (2008) Continuous wound infusion of local anaesthetic agents following colorectal surgery: systematic review and meta-analysis. World J Gastroenterol 14:5301–5305CrossRef Karthikesalingam A, Walsh SR, Markar SR, Sadat U, Tang TY, Malata CM (2008) Continuous wound infusion of local anaesthetic agents following colorectal surgery: systematic review and meta-analysis. World J Gastroenterol 14:5301–5305CrossRef
14.
go back to reference Reinikainen M, Syvaoja S, Hara K (2014) Continuous wound infiltration with ropivacaine for analgesia after caesarean section: a randomised, placebo-controlled trial. Acta Anaesthesiol Scand 58:973–979CrossRef Reinikainen M, Syvaoja S, Hara K (2014) Continuous wound infiltration with ropivacaine for analgesia after caesarean section: a randomised, placebo-controlled trial. Acta Anaesthesiol Scand 58:973–979CrossRef
15.
go back to reference Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD (2006) Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 202:297–305CrossRef Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD (2006) Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg 202:297–305CrossRef
16.
go back to reference Kong TW, Park H, Cheong JY, Min SK, Ryu HS (2014) Efficacy of continuous wound infiltration of local anesthetic for pain relief after gynecologic laparoscopy. Int J Gynaecol Obstet 124:212–215CrossRef Kong TW, Park H, Cheong JY, Min SK, Ryu HS (2014) Efficacy of continuous wound infiltration of local anesthetic for pain relief after gynecologic laparoscopy. Int J Gynaecol Obstet 124:212–215CrossRef
17.
go back to reference Florkiewicz P, Musialowicz T, Hippeläinen M, Lahtinen P (2019) Continuous ropivacaine infusion offers no benefit in treating postoperative pain after cardiac surgery. J Cardiothorac Vasc Anesth 33:378–384CrossRef Florkiewicz P, Musialowicz T, Hippeläinen M, Lahtinen P (2019) Continuous ropivacaine infusion offers no benefit in treating postoperative pain after cardiac surgery. J Cardiothorac Vasc Anesth 33:378–384CrossRef
Metadata
Title
Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial
Authors
Nae Hyun Lee
Kyoungho Ryu
Taejong Song
Publication date
01-02-2021
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 2/2021
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07416-8

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