scholarly journals Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

2021 ◽  
Vol 10 (20) ◽  
pp. 4659
Author(s):  
Dusica M. Stamenkovic ◽  
Mihailo Bezmarevic ◽  
Suzana Bojic ◽  
Dragana Unic-Stojanovic ◽  
Dejan Stojkovic ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Local Anesthetic ◽  
Wound Closure ◽  
Postoperative Pain Management ◽  
Abdominal Hysterectomy ◽  
Multimodal Analgesia ◽  
Direct Visualization ◽  
Surgical Wound ◽  
Wound Infiltration ◽  
Local Anesthetic Systemic Toxicity

Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient’s mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with “aseptic, non-touch” technique are needed.

scholarly journals PROSPECT guideline for hallux valgus repair surgery: a systematic review and procedure‐specific postoperative pain management recommendations

2020 ◽  
Vol 45 (9) ◽  
pp. 702-708
Author(s):  
Katarzyna Korwin-Kochanowska ◽  
Arnaud Potié ◽  
Kariem El-Boghdadly ◽  
Narinder Rawal ◽  
Girish Joshi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Pain Management ◽  
Postoperative Pain ◽  
Hallux Valgus ◽  
Local Anesthetic ◽  
Postoperative Pain Management ◽  
Inclusion Criteria ◽  
Wound Infiltration ◽  
Systemic Steroids ◽  
Anti Inflammatory

Hallux valgus repair is associated with moderate-to-severe postoperative pain. The aim of this systematic review was to assess the available literature and develop recommendations for optimal pain management after hallux valgus repair. A systematic review using PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomized controlled trials (RCTs) published in the English language from inception of database to December 2019 assessing postoperative pain using analgesic, anesthetic, and surgical interventions were identified from MEDLINE, EMBASE, and Cochrane Database, among others. Of the 836 RCTs identified, 55 RCTs and 1 systematic review met our inclusion criteria. Interventions that improved postoperative pain relief included paracetamol and non-steroidal anti-inflammatory drugs or cyclo-oxygenase-2 selective inhibitors, systemic steroids, ankle block, and local anesthetic wound infiltration. Insufficient evidence was found for the use of gabapentinoids or wound infiltration with extended release bupivacaine or dexamethasone. Conflicting evidence was found for percutaneous chevron osteotomy. No evidence was found for homeopathic preparation, continuous local anesthetic wound infusion, clonidine and fentanyl as sciatic perineural adjuncts, bioabsorbable magnesium screws, and plaster slippers. No studies of sciatic nerve block met the inclusion criteria for PROSPECT methodology due to a wider scope of included surgical procedures or the lack of a control (no block) group. The analgesic regimen for hallux valgus repair should include, in the absence of contraindication, paracetamol and a non-steroidal anti-inflammatory drug or cyclo-oxygenase-2 selective inhibitor administered preoperatively or intraoperatively and continued postoperatively, along with systemic steroids, and postoperative opioids for rescue analgesia.

scholarly journals Surgical wound infiltration by local anesthetic: Wound infiltration

2019 ◽  
Vol 41 (7-8) ◽  
pp. 143-155
Author(s):  
Damjan Slavković ◽  
Zoran Kostić ◽  
Nikolina Milošević ◽  
Nemanja Rančić ◽  
Viktorija Dragojević-Simić ◽  
...  
Keyword(s):  
Local Anesthetic ◽  
Surgical Wound ◽  
Wound Infiltration

Transdermal Buprenorphine- A novel Medication for Postoperative Pain Management Following Abdominal Hysterectomy for Benign Gynecological Conditions

2021 ◽  
Vol 17 ◽  
Author(s):  
Aarti Yevale ◽  
Jyothi Shetty ◽  
Vidyashree G Poojari ◽  
Vasudeva Guddattu
Keyword(s):  
Postoperative Pain ◽  
Pain Relief ◽  
Postoperative Nausea And Vomiting ◽  
Postoperative Pain Management ◽  
Abdominal Hysterectomy ◽  
Postoperative Pain Relief ◽  
Safe Alternative ◽  
Intravenous Paracetamol ◽  
Semisynthetic Derivative ◽  
Time Frames

Background: Buprenorphine is a semisynthetic derivative of thebaine which is 75–100 times more potent than morphine and causes less respiratory depression. Efficacy and safety of transdermal buprenorphine have been well established in chronic pain, but data regarding acute postoperative pain relief are still limited. Aim: In this study we compared the efficacy of transdermal buprenorphine patch with injectable tramadol for the relief of postoperative pain (POP) following abdominal hysterectomy for benign gynecological conditions. Settings and design: three-year prospective observational study. Methods and material: One hundred patients undergoing abdominal hysterectomy were allocated to one of two groups. Buprenorphine group: we applied 10 mcg/hr transdermal buprenorphine patch on the lateral upper arm after surgery. The onset of relief from a patch is 8 to 16 hours. So, all patients were given diclofenac suppository 100mg before induction of anesthesia as preemptive analgesic to reduce postoperative pain. Injectable tramadol group : received intramuscular tramadol injections 50mg every 8 hours in the postoperative period. Patients were followed for two days to look for postoperative pain relief and adverse effects. If patients showed a visual analog pain (VAS) score >3, intravenous paracetamol was administered as rescue analgesic. Results: POP was assessed at different time frames: 12, 24, 36 and 48 hours after hysterectomy. Mean pain score at rest, in buprenorphine group was significantly lower than that of the tramadol group. Patients experienced less pain on mobility in the buprenorphine group compared with the tramadol group, which was statistically significant. Conclusion: We concluded that transdermal buprenorphine is an effective and safe alternative to injectable tramadol for providing postoperative analgesia. It provides a higher degree of pain relief, faster postoperative mobilization, lower incidence of postoperative nausea and vomiting and higher satisfaction scores starting 12 hours after surgery. However, for the first 12 post-operative hours, there is need for additional analgesia.

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