Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

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

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.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2

References

  1. 1.

    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. 2.

    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 18:387–399

  3. 3.

    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 29:3–11

  4. 4.

    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 91:1436–1440

  5. 5.

    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 186:1188–1191

  6. 6.

    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. 7.

    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 24:576–580

  8. 8.

    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 106:227–233

  9. 9.

    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 42:515–518

  10. 10.

    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 35:416–421

  11. 11.

    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. 12.

    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 101:841–847

  13. 13.

    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 14:5301–5305

  14. 14.

    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 58:973–979

  15. 15.

    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 202:297–305

  16. 16.

    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 124:212–215

  17. 17.

    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 33:378–384

Download references

Funding

None.

Author information

Correspondence to Taejong Song.

Ethics declarations

Disclosures

Nae Hyun Lee, Kyoungho Ryu, and Taejong Song have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lee, N.H., Ryu, K. & Song, T. Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial. Surg Endosc (2020). https://doi.org/10.1007/s00464-020-07416-8

Download citation

Keywords

  • Continuous wound infusion
  • Postoperative pain
  • Laparoscopy
  • Laparoendoscopic single-site surgery
  • Pain management