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Continuous wound infusion with ropivacaine alone provides adequate analgesia following laparotomy

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Abstract

Background

Although continuous wound infusion (CWI) with local anaesthetic has been used as an adjunct for pain relief following laparotomy, its use as the main modality has not been studied. This approach negates side effects related to intravenous opioid administration, therefore promoting enhanced recovery from surgery. We conducted this study to investigate the feasibility and efficacy of CWI following laparotomy.

Methods

Consecutive patients who underwent laparotomy from June 2016 to December 2019 were analysed. All patients were given CWI with only oral supplementation. Pain was assessed based on the numeric rating scale (NRS).

Results

One hundred and three patients were analysed. Mean age was 61.1 (standard deviation 16.7). 47.6% of patients were operated for intestinal obstruction. Large bowel resection was the most common operation performed (49.5%). 69.9% of patients underwent emergency surgery, whilst 51.5% of patients had surgery for cancer. On postoperative day 0, NRS was 3.2 (standard deviation (sd) 2.6) which decreased to 1.5 (sd 1.9) on day 3, and 1.1 (sd 1.8) on day 5. Mean time to flatus was 2.3 (sd 1.4) days, whilst mean time to first bowel movement was 3.1 (sd 1.7) days. Patients were able to commence ambulation by 2.5 (sd 1.8) days. Patients could tolerate a normal diet on day 3.9 (sd 3.3), and IV drip was removed on day 3.5 (sd 3.0). Mean length of stay was 9.1 (sd 6.9) days. Only two patients suffered from respiratory depression (1.9%) whilst five patients suffered from hypotension (4.9%). No patients had pruritus. 23.3% of patients had nausea or vomiting. Only one patient had a catheter-related complication which was easily addressed.

Conclusion

CWI provides adequate pain relief as the principle modality of analgesia after surgery, without opioid side effects.

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Authors and Affiliations

  1. Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health System, System, 1E Kent Ridge Road, Singapore, 119228, Singapore

    Dedrick Kok Hong Chan

  2. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Dedrick Kok Hong Chan

  3. Department of General Surgery, Ng Teng Fong General Hospital, National University Health System, Singapore, Singapore

    Rebecca Wenhui Goh & Christopher Hang Liang Keh

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  1. Dedrick Kok Hong Chan
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  2. Rebecca Wenhui Goh
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Contributions

Dedrick Kok Hong Chan, Rebecca Wenhui Goh and Christopher Hang Liang Keh participated in the analysis of data and final editing of the manuscript. In addition, Dedrick Kok Hong Chan participated in the initial writing of the manuscript. Rebecca Wenhui Goh participated in the collection of data. Christopher Hang Liang Keh was also overall in charge of the manuscript.

Corresponding author

Correspondence to Dedrick Kok Hong Chan.

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The authors declare that they have no conflict of interests.

Research involving human participants

This article does not contain any studies with human participants performed by any of the authors. This study has been approved by the National Healthcare Group Domain Specific Review Board.

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Consent from individual participants was not obtained for this study. Waiver of consent was obtained from the ethic committee due to the nature of the study.

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Chan, D.K.H., Goh, R.W. & Keh, C.H.L. Continuous wound infusion with ropivacaine alone provides adequate analgesia following laparotomy. Langenbecks Arch Surg 406, 413–418 (2021). https://doi.org/10.1007/s00423-020-02047-y

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  • DOI: https://doi.org/10.1007/s00423-020-02047-y

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