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Continuous local anaesthetic wound infusion

Lorenzo Ball, Giulia Pellerano, Laura Corsi, Nadia Giudici, Anna Pellegrino, Daniela Cannata, Gregorio Santori, Domenico Palombo, Paolo Pelosi, Angelo Gratarola
BACKGROUND: We compared a bundle of interventions including wound infiltration and continuous infusion with local anaesthetics plus a single morphine bolus (CWI-M) with continuous epidural infusion (CEI) as postoperative analgesia. METHODS: Fifty-one adults undergoing open abdominal aortic aneurysm repair were randomised in this non-inferiority open-label trial. In the CEI group, patients received thoracic epidural levobupivacaine 0.12% plus sufentanil 0.4 g·ml-1 infusion for 48h...
August 30, 2016: Minerva Anestesiologica
S Telletxea, J Gonzalez, V Portugal, R Alvarez, U Aguirre, A Anton, A Arizaga
OBJECTIVES: For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects. METHODS: We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013...
April 2016: Revista Española de Anestesiología y Reanimación
M S Machoki, A J W Millar, H Albetyn, S G Cox, J Thomas, A Numanoglu
INTRODUCTION: Local anesthetic wound infusion has shown promising results in adults. Its use in children is limited to some centers and there are only a few prospective trials in this group of patients. METHODS: Sub-fascial continuous local anaesthetic wound infusion (CLAWI) (0.2% Bupivacaine) plus intravenous paracetamol and rescue intravenous morphine was compared to: (a) Epidural bupivacaine (EPI) plus paracetamol and rescue intravenous morphine for patients undergoing laparotomy...
November 2015: Pediatric Surgery International
Christian Uhl, Thomas Betz, Andrea Rupp, Markus Steinbauer, Ingolf Töpel
BACKGROUND: This pilot study was set up to examine the effects of a continuous postoperative wound infusion system with a local anaesthetic on perioperative pain and the consumption of analgesics. PATIENTS AND METHODS: We included 42 patients in this prospective observational pilot study. Patients were divided into two groups. One group was treated in accordance with the WHO standard pain management protocol and in addition to that received a continuous local wound infusion treatment (Group 1)...
September 2015: VASA. Zeitschrift Für Gefässkrankheiten
Joachim Krylborn, Marie E Anell-Olofsson, Catarina Bitkover, Stefan Lundeberg, Marco Bartocci, Carl-Olav Stiller, Bjorn A Larsson
BACKGROUND: Epidurals may be challenging in neonatal patients due to technical difficulties relating to insertion and the risk of local anaesthesia toxicity. The use of wound catheters with an infusion of local anaesthetic has been shown to be well tolerated in adults and older children. There are few data concerning wound catheter techniques in neonatal patients. OBJECTIVES: The primary aim of this study was to analyse plasma levels of levobupivacaine associated with continuous wound infiltration via a catheter following neonatal surgical procedures...
December 2015: European Journal of Anaesthesiology
Alfonso Fiorelli, Anna Cecilia Izzo, Elisabetta Maria Frongillo, Assunta Del Prete, Giovanni Liguori, Emilio Di Costanzo, Giovanni Vicidomini, Mario Santini
OBJECTIVES: Continuous wound infusion of local anaesthetics has been successfully applied for postoperative pain control in several procedures but, surprisingly, it is underused in thoracic surgery. We aimed to investigate the effects of wound analgesia associated with systemic patient-controlled analgesia in patients undergoing lung cancer resection with muscle-sparing thoracotomy. METHODS: Sixty consecutive patients undergoing lung cancer resection via standard muscle-sparing thoracotomy were randomized into two groups (wound analgesia and placebo groups)...
January 2016: European Journal of Cardio-thoracic Surgery
J Barr, C Boulind, J D Foster, P Ewings, J Reid, J T Jenkins, B Williams-Yesson, N K Francis
BACKGROUND: Epidural analgesia is perceived to modulate the stress response after open surgery. This study aimed to explore the feasibility and impact of measuring the stress response attenuation by post-operative analgesic modalities following laparoscopic colorectal surgery within an enhanced recovery after surgery (ERAS) protocol. METHODS: Data were collected as part of a double-blinded randomised controlled pilot trial at two UK sites. Patients undergoing elective laparoscopic colorectal resection were randomised to receive either thoracic epidural analgesia (TEA) or continuous local anaesthetic infusion to the extraction site via wound infusion catheter (WIC) post-operatively...
April 2015: Techniques in Coloproctology
N Fustran, A Dalmau, E Ferreres, I Camprubí, R Sanzol, S Redondo, E Kreisler, S Biondo, A Sabaté
AIM: The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine. METHOD: Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy...
April 2015: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Shane Raines, Cecilia Hedlund, Malin Franzon, Stefan Lillieborg, Glen Kelleher, Kjell Ahlén
BACKGROUND: The use of continuous wound infusion (CWI) of local anaesthetics has been suggested as a safe and effective alternative technique to epidural anaesthesia/analgesia that allows surgeons to provide postoperative pain relief while reducing opioid consumption and associated adverse events. A previous meta-analysis by Liu et al. [Am Coll Surg 2006;203:914-932] reported results mainly from studies of bupivacaine. Subsequently, several new randomized controlled trials (RCTs) of ropivacaine have been published...
2014: European Surgical Research. Europäische Chirurgische Forschung. Recherches Chirurgicales Européennes
Branka Strazisar, Nikola Besic, Uros Ahcan
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...
2014: World Journal of Surgical Oncology
N T Ventham, M Hughes, S O'Neill, N Johns, R R Brady, S J Wigmore
BACKGROUND: Local anaesthetic wound infiltration techniques reduce opiate requirements and pain scores. Wound catheters have been introduced to increase the duration of action of local anaesthetic by continuous infusion. The aim was to compare these infiltration techniques with the current standard of epidural analgesia. METHODS: A meta-analysis of randomized clinical trials (RCTs) evaluating wound infiltration versus epidural analgesia in abdominal surgery was performed...
September 2013: British Journal of Surgery
Branka Strazisar, Nikola Besic
BACKGROUND: Acute pain after axillary lymphadenectomy is often related mainly to axillary surgery. The aim of the prospective randomized study was to find out if continuous wound infusion of local anaesthetic reduces postoperative pain, consumption of opioids and the incidence of chronic pain compared to the standard intravenous piritramide analgesia after axillary lymphadenectomy in breast carcinoma patients. METHODS: Altogether 60 patients were enrolled in the prospective randomized study; half in wound infusion of local anaesthetic and half in the standard (piritramide) group...
June 2013: Radiology and Oncology
Olga Hermansson, Mary George, Tomas Wester, Rolf Christofferson
BACKGROUND: Local anaesthetic infusions into the surgical wound have been shown to reduce postoperative pain and the need for opioids in adults. In children, it was found to be safe and efficacious following sternotomy and orthopaedic surgery. The aim of this study was to evaluate the need for opioids postoperatively in children receiving wound catheters delivering either bupivacaine or saline following one of three defined abdominal or bladder procedures. METHODS: Prospective, randomized, double-blind, placebo controlled study...
May 2013: Pediatric Surgery International
C E Boulind, P Ewings, S H Bulley, J M Reid, J T Jenkins, J M Blazeby, N K Francis
BACKGROUND: With the adoption of enhanced recovery and emerging new modalities of analgesia after laparoscopic colorectal resection (LCR), the role of epidural analgesia has been questioned. This pilot trial assessed the feasibility of a randomized controlled trial (RCT) comparing epidural analgesia and use of a local anaesthetic wound infusion catheter (WIC) following LCR. METHODS: Between April 2010 and May 2011, patients undergoing elective LCR in two centres were randomized to analgesia via epidural or WIC...
February 2013: British Journal of Surgery
Narinder Rawal
Epidural analgesia is a well-established technique that has commonly been regarded as the gold standard in postoperative pain management. However, newer, evidence-based outcome data show that the benefits of epidural analgesia are not as significant as previously believed. There are some benefits in a decrease in the incidence of cardiovascular and pulmonary complications, but these benefits are probably limited to high-risk patients undergoing major abdominal or thoracic surgery who receive thoracic epidural analgesia with local anaesthetic drugs only...
May 2012: Regional Anesthesia and Pain Medicine
J P Kainu, J Sarvela, P Halonen, H Puro, H J Toivonen, E Halmesmäki, K T Korttila
BACKGROUND: Continuous wound infusion with local anaesthetic has been used in post-caesarean pain management with conflicting results. We carried out a study comparing three groups: continuous ropivacaine wound infusion, intrathecal morphine with saline wound infusion and saline wound infusion only. METHODS: Sixty-six women undergoing elective caesarean section under combined spinal-epidural anaesthesia were randomly allocated to receive intrathecal morphine with saline wound infusion or 48 h continuous wound infusion with either ropivacaine or saline...
April 2012: International Journal of Obstetric Anesthesia
G P Joshi, N Rawal, H Kehlet, F Bonnet, F Camu, H B J Fischer, E A M Neugebauer, S A Schug, C J P Simanski
BACKGROUND: Open inguinal hernia repair is associated with moderate postoperative pain, but optimal analgesia remains controversial. The aim of this systematic review was to evaluate the available literature on the management of pain after open hernia surgery. METHODS: Randomized studies, in English, published between January 1966 and March 2009, assessing analgesic and anaesthetic interventions in adult open hernia surgery, and reporting pain scores, were retrieved from the Embase and MEDLINE databases...
February 2012: British Journal of Surgery
Marina Campolo, Dafne Molin, Narinder Rawal, Alfredo Soldati
Multi-holed wound catheters are increasingly used in clinical practice to administer analgesic/anaesthetic locally to the painful region. The distribution of flow infused during controlled (continuous or intermittent) administration of medication is believed to be an important issue for successful pain relief. Nevertheless, this information is not available from the literature. In this paper, we propose protocols to screen the performance of wound infusion catheters in the laboratory environment. Four wound infusion systems (PAINfusor by Baxter, OnQ Pump with Soaker catheter by I-Flow, PolyFuser Polymedic by Temena and Infiltralong by Pajunk) have been tested...
April 2012: Medical Engineering & Physics
Félix Lluis, Manuel Romero Simó, Juan Francisco Márquez Peiró, Juan Selva Otaolaurruchi, Antonio Zarco
OBJECTIVE: To evaluate the incidence of infection at the surgical site in patients who have a multiperforated catheter implant for continuous infusion of a local anaesthetic as a local analgesic. PATIENTS AND METHOD: An observational, descriptive and prospective study, of one month duration. It included 50 patients subjected to selective laparotomy in whom a multiperforated pre-peritoneal catheter was implanted for analgesia purposes (Painfusor®. Baxter). Patients with a surgical incision of less than 15 cm and/or ASA>III, were excluded from the study...
November 2011: Cirugía Española
J E Chelly, D Ghisi, A Fanelli
The indications for continuous nerve blocks for the perioperative pain management in hospitalized and ambulatory patients have extended well beyond orthopaedics. These techniques are not only used to control pain in patients undergoing major upper and lower extremity surgery, but also to provide perioperative analgesia in patients undergoing abdominal, plastic, urological, gynaecological, thoracic, and trauma surgeries. Infusion regimens of local anaesthetics and supplements must take into consideration the condition of the patient before and after surgery, the nature and intensity of the surgical stress associated with the surgery, and the possible need for immediate functional recovery...
December 2010: British Journal of Anaesthesia
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