Skip to main content

Advertisement

SpringerLink
Log in

Continuous Wound Infusion of Local Anesthetic for the Control of Pain After Elective Abdominal Colorectal Surgery

  • Original Contributions
  • Published:
Diseases of the Colon & Rectum

Abstract

Purpose

Local anesthetic wound infusion has been investigated in recent years as a potential alternative to standard analgesic regimens after major surgery. This study investigates the efficacy of a continuous wound infusion of ropivacaine in conjunction with best practice postoperative analgesia after midline laparotomy for abdominal colorectal surgery.

Methods

We performed a randomized, participant and outcome assessor-blinded, placebo-controlled trial on patients presenting for major abdominal colorectal surgery at our institution between December 2003 and February 2006. Patients were allocated to receive ropivacaine 0.54 percent or normal saline via a dual catheter Painbuster Soaker™ (I-Flow Corporation, OH, USA) continuous infusion device into their midline laparotomy wound for 72 hours postoperatively.

Results

A total of 310 patients were included in this study. The continuous wound infusion of ropivacaine after abdominal colorectal surgery conveys minimal benefit compared with saline wound infusion. No statistically significant difference could be shown for: pain at rest, morphine usage, length of stay, mobility, nausea, or return of bowel function. There was a small, statistically significant difference in mean pain on movement on Day 1 for the ropivacaine group (adjusted mean difference −0.6 (range, −1.08 to −0.13)). Although this trend continued on Days 2 and 3, the differences between groups were no longer statistically significant.

Conclusions

Management of pain after major abdominal colorectal surgery is best achieved through adopting a multimodal approach to analgesia. Delivery of ropivacaine to midline laparotomy wounds via a Painbuster Soaker™ device is safe, but we have not demonstrated any significant clinical advantage over current best practice.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Figure 1

Similar content being viewed by others

References

  1. Kushner DM, LaGalbo R, Connor JP, Chappell R, Stewart SL, Hartenbach EM. Use of bupivacaine continuous wound infusion system in gynecologic oncology: a randomized trial. Obstet Gynecol 2005;106:227–33.

    PubMed  CAS  Google Scholar 

  2. PROSPECT working group – procedure specific postoperative pain management: open colonic resection. Available at: http://www.postoppain.org/frameset.htm. Accessed March 27, 2006.

  3. Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine. Acute Pain Management Scientific Evidence. 2nd ed. 2005:102–33. Available at: http://www.nhmrc.gov.au/publications/synopses/_files/cp104.pdf. Accessed August 12, 2006.

  4. Lui S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995;82:1474–506.

    Article  Google Scholar 

  5. Sinclair R, Cassuto J, Hogstrom S, et al. Topical anaesthesia with lidocaine aerosol in the control of postoperative pain. Anaesthesiology 1988;68:895–901.

    Article  CAS  Google Scholar 

  6. Bays RA, Barry L, Vasilenko P. The use of bupivacaine in elective inguinal herniorraphy as a fast and safe technique for the relief of postoperative pain. Surg Gynecol Obstet 1991;173:433–7.

    PubMed  CAS  Google Scholar 

  7. Dierking GW, Ostergaard E, Ostergaard HT, Dahl JB. The effect of wound infiltration of bupivacaine versus saline on postoperative pain and opioid requirements after herniorraphy. Acta Anaesthesiol Scand 1994:38:289–92.

    PubMed  CAS  Google Scholar 

  8. Johansson B, Hallerback B, Stubberod A, et al. Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair. Eur J Surg 1997;163:371–8.

    PubMed  CAS  Google Scholar 

  9. Tverskoy M, Cozacov C, Ayache M, Bradley EL, Kissin I. Postoperative pain after inguinal herniorraphy with different types of analgesia. Anesth Analg 1990;70:29–35.

    Article  PubMed  CAS  Google Scholar 

  10. Moiniche S, Mikkelsen S, Wetterslev J, Dahl JB. A qualitative systemic review of incisional local anaesthesia for postoperative pain relief after abdominal operations. Br J Anaesth 1998;81:377–83.

    PubMed  CAS  Google Scholar 

  11. Patel JM, Lanzafame RJ, Williams JS, Mullen BV, Hinshaw JR. The effect of incisional infiltration of bupivacaine hydrochloride upon pulmonary functions, atelectasis and narcotic need following elective cholecystectomy. Surg Gynecol Obstet 1983;157:338–40.

    PubMed  CAS  Google Scholar 

  12. Partridge BL, Stabile BE. The effects of incisional bupivacaine on postoperative narcotic requirements, oxygen saturation and length of stay in the post-anesthesia care unit. Acta Anaesthesiol Scand 1990;34:486–91.

    Article  PubMed  CAS  Google Scholar 

  13. Thomas DF, Lambert WG, Lloyd-Williams K. The direct perfusion of surgical wounds with local anaesthetic solution: an approach to postoperative pain? Ann R Coll Surg Engl 1983;65:226–9.

    PubMed  CAS  Google Scholar 

  14. Levack ID, Holmes JD, Robertson GS. Abdominal wound perfusion for the relief of post-operative pain. Br J Anaesth 1986;58:615–9.

    Article  PubMed  CAS  Google Scholar 

  15. Mecklem DW, Humphrey MD, Hicks RW. Efficacy of bupivacaine delivered by wound catheter for post-Caesarean section analgesia. Aust N Z J Obstet Gynaecol 1995;35:416–21.

    PubMed  CAS  Google Scholar 

  16. Gibbs P, Puroshotham A, Auld C, Cushieri RJ. Continuous wound perfusion with bupivacaine for postoperative wound pain. Br J Surg 1988;75:923–4.

    Article  PubMed  CAS  Google Scholar 

  17. Chester JF, Ravindranath K, White BD, Shanahan D, Taylor RS, Lloyd-Williams K. Wound perfusion with bupivacaine: objective evidence for efficacy in postoperative pain relief. Ann R Coll Surg Engl 1989;71:394–6.

    PubMed  CAS  Google Scholar 

  18. Chen TF, Clarke N, Bowen R, Harper NJ, Payne SR. Intermuscular bupivacaine infusion for control of pain after renal surgery: a preliminary report. Br J Urol 1994;74:155–9.

    PubMed  CAS  Google Scholar 

  19. LeBlanc KA, Bellanger D, Rhynes VK, Hausmann M. Evaluation of continuous infusion of 0.5% bupivacaine by elastomeric pump for postoperative pain management after open inguinal hernia repair. J Am Coll Surg 2005;200:198–202.

    Article  PubMed  Google Scholar 

  20. Baig MK, Zmora O, Derdemezi J, Weiss EG, Nogueras JJ, Wexner SD. 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 2006;202:297–305.

    Article  PubMed  Google Scholar 

  21. Cheong WK, Seow-Choen F, Eu KW, Tang CL, Heah SM. Randomised clinical trial of local bupivacaine perfusion versus parenteral morphine infusion for pain relief after laparotomy. Br J Surg 2001;88:357–9.

    Article  PubMed  CAS  Google Scholar 

  22. Therapeutic Goods Administration. Media Statement – Expanded information on Cox-2 inhibitors for doctors and pharmacists. Available at: http://www.tga.gov.au/media/2005/050214_cox2.htm. Accessed November 11, 2006.

  23. MIMS Online, Torodol-ketorolac trometamol (Roche Products Pty Ltd), Copyright MIMS Australia Pty Ltd 2003. Available at: http://www.mims.com.au. Accessed November 11, 2006.

  24. Thorson A, Faria J. United European Gastroenterology Week 2001. The On-Q Pain Management System in the control of post-operative pain in colon and rectal surgery [abstract]. Available at: http://www.iflo.com/clinical_library.php. Accessed March 15, 2006.

  25. StataCorp. 2005. Stata Statistical Software: Release 9. College Station, TX: StataCorp. Available at: http://www.stata.com/.

  26. Rigg JR, Jamrozik K, Myles PS, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomized trial. Lancet 2002:359:1276–82. Available at: http://proquest.umi.com/pqdlink Document ID: 114485829.

    Google Scholar 

  27. Fredman B, Zohar E, Tarabykin A, et al. Bupivacaine wound instillation via an electronic patient-controlled analgesia device and a double-catheter system does not decrease postoperative pain or opioid requirements after major abdominal surgery. Anesth Analg 2001;92:189–93.

    Article  PubMed  CAS  Google Scholar 

  28. Cornish P, Deacon A. Rectus sheath catheters for continuous analgesia after upper abdominal surgery. ANZ J Surg 2007;77:84.

    Article  PubMed  Google Scholar 

  29. Schug SA, Sidebotham DA, Mcguinnety M, Thomas J, Fox L. Acetaminophen as an adjunct to morphine by patient controlled analgesia in the management of acute postoperative pain. Anesth Analg 1998;87:368–72.

    Article  PubMed  CAS  Google Scholar 

  30. Hyllested M, Jones S, Pederson JL, Kehlet H. Comparative effect of paracetamol, NSAIDs or their combination in postoperative pain management: a qualitative review. Br J Anaesth 2002;88:199–214.

    Article  PubMed  CAS  Google Scholar 

  31. Romsing J, Moiniche S, Dahl JB. Rectal and parenteral paracetamol, and paracetamol in combination with NSAIDs, for postoperative analgesia. Br J Anaesth 2002;88:215–26.

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors thank associate professor Damien Jolley, Monash Institute of Health Services Research, Monash University, Clayton, Victoria, for assistance with biostatistics and analysis of data.

Author information

Authors and Affiliations

  1. Department of Surgery, Cabrini Monash University, Cabrini Health, Malvern, Victoria, Australia

    Adrian L. Polglase F.R.A.C.S., Paul J. McMurrick F.R.A.C.S., Paul J. B. Simpson M.B.B.S., L.L.B., Roger J. Wale F.R.A.C.S., Peter W. G. Carne F.R.A.C.S., William Johnson F.R.A.C.S., Justin Chee M.B.B.S., Corrine W. Ooi M.B.B.S., Jennifer W. D. Chong M.B.B.S. & Rachelle Buchbinder Ph.D.

  2. Department of Human Services, Victorian Public Health Training Scheme, Clifton Hill, Victoria, Australia

    Sally R. Kingsland B.Sc.(Hons.)

  3. Suite 20 Cabrini Health, 183 Wattletree Road, Malvern, Victoria, 3144, Australia

    Adrian L. Polglase F.R.A.C.S.

Authors
  1. Adrian L. Polglase F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Paul J. McMurrick F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Paul J. B. Simpson M.B.B.S., L.L.B.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Roger J. Wale F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Peter W. G. Carne F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. William Johnson F.R.A.C.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Justin Chee M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Corrine W. Ooi M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jennifer W. D. Chong M.B.B.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Sally R. Kingsland B.Sc.(Hons.)
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Rachelle Buchbinder Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adrian L. Polglase F.R.A.C.S..

Additional information

Supported by Tackling Bowel Cancer – Cabrini Hospital Clinical Education and Research Institute Melbourne, Victoria, Australia; Mazda Foundation – Private Bag 40 Mount Waverly, Victoria 3149; and I-Flow Corporation, Pleasant Plain, Ohio: Supplied Painbuster Soaker™ devices for this trial.

Reprints are not available.

About this article

Cite this article

Polglase, A.L., McMurrick, P.J., Simpson, P.J.B. et al. Continuous Wound Infusion of Local Anesthetic for the Control of Pain After Elective Abdominal Colorectal Surgery. Dis Colon Rectum 50, 2158–2167 (2007). https://doi.org/10.1007/s10350-007-9081-7

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-007-9081-7

Key words

Search

Navigation