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Postoperative Analgesia: Randomized Prospective Study Comparing Epidural Catheter Infusion and Continuous Wound Catheter Infusion of Local Anaesthesia

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Abstract

Control of acute postoperative pain is a requirement in modern surgical practice. Opioid and non-opioid analgesics and epidural analgesia (EA) are used to achieve relief from postoperative pain. Each of these has its share of difficulties and complications. Continuous wound infusion (CWI) of local anaesthetics has also been employed. This study aims to compare CWI with EA in managing postoperative pain. In a randomized controlled study, patients undergoing laparotomy were allocated into two groups prior to surgery: Group 1 received epidural analgesia postoperatively and group 2 received continuous wound infusion of local anaesthetic postoperatively. The study compared the quality of postoperative analgesia measured using a standard validated visual analogue scale (VAS), the frequency and dosage of rescue analgesia over 48 h postsurgery, bowel recovery time, complications due to pain, and hospital stay. Forty-two patients were included in the study. The two groups being studied were statistically comparable. The pain scores were lower in the wound infusion group at the second (p = 0.03), third (p = 0.035), and fourth time (p < 0.01) interval recordings (at p = 0.05) compared with those in the epidural group. Rescue analgesia usage was seen to be greater in the epidural group at the first (p = 0.041), second (p = 0.01), and fifth (0.007) time interval recording (at p = 0.05). Time of independent mobilization and duration of hospital stay were 1.7 days and 5.6 days respectively and were seen to be significantly lower in the wound infusion group (p < 0.05). Continuous wound catheter infusion of local anaesthetic is as effective as epidural analgesia in treating postoperative pain. Continuous wound infusion catheter may be a better alternative because of the ease of institution, early ambulation, and shorter duration of hospital stay.

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Authors and Affiliations

  1. Department of General Surgery, Sagar Hospitals, NO 319 1st cross 3rd Stage 4th Block, Basaveshwara Nagar, Bangalore, Karnataka, 560079, India

    Vibha Ramesh & Ajay Raghunath Aspari

  2. Department of General Surgery, Sagar Hospitals, NO 58/4 2nd Main 1st Block, Thyagarajanagar, Bangalore, Karnataka, 560028, India

    Krishnaswamy Lakshman

  3. Department of Anaesthesia, Sagar Hospitals, Bangalore, India

    Nayakanur Shankarappa Chandrashekara

  4. Trustwell Hospitals, NO 5, J.C Road, Bangalore, Karnataka, 560022, India

    Nayakanur Shankarappa Chandrashekara

  5. Department of General Surgery, Sagar Hospitals, Anugraha, 6th cross, Vidyanagar, Tumkur, Karnataka, 572103, India

    Niranjan Paramashivaiah

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  1. Vibha Ramesh
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  2. Ajay Raghunath Aspari
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  3. Krishnaswamy Lakshman
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  4. Nayakanur Shankarappa Chandrashekara
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Correspondence to Vibha Ramesh.

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The authors declare that they have no conflicts of interest.

Research Involving Human Participants

This is a comparative study of two modalities of analgesia. Similar studies have been done proving the efficacy of the newer technique. Our study methodology was based on recommendations from previous studies on the subject.

Informed Consent

Patients were explained about the nature of interventions being studied before recruitment into the study. The inclusion into the study was done only after obtaining an informed consent.

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Ramesh, V., Aspari, A.R., Lakshman, K. et al. Postoperative Analgesia: Randomized Prospective Study Comparing Epidural Catheter Infusion and Continuous Wound Catheter Infusion of Local Anaesthesia. Indian J Surg 82, 1067–1073 (2020). https://doi.org/10.1007/s12262-020-02243-6

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  • DOI: https://doi.org/10.1007/s12262-020-02243-6

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