Analgesia with continuous wound infusion of local anesthetic versus saline: Double-blind randomized, controlled trial in hepatectomy

Am J Surg. 2018 Jan;215(1):138-143. doi: 10.1016/j.amjsurg.2017.09.007. Epub 2017 Sep 20.

Abstract

Background: Surgical wound is source of pain in hepatectomy with laparotomy. Continuous wound infusion of ropivacaine may provide effective analgesia.

Methods: This prospective, randomized trial, patients scheduled for hepatectomy received a 48-h preperitoneal continuous wound infusion of either 0.23% ropivacaine or 0.9% saline at 5 ml/h. Primary endpoint was 48 h morphine consumption.

Results: 53 patients included in the ropivacaine group and 46 in the saline group. Morphine consumption was 24.63 mg in the ropivacaine group, and 26.78 mg (p = 0.669) in the saline group. Pain was comparable between groups and there were no differences in solid food intake, ambulation, or length of hospital stay. No local or systemic complications were recorded.

Conclusions: Continuous wound infusion with ropivacaine is safe, but it neither reduced morphine consumption nor enhanced recovery in patients undergoing hepatectomy. Success of enhanced recovery in hepatectomy is not influenced by the analgesic regimen if pain is well controlled.

Keywords: Enhanced recovery; Incisional analgesia; Liver resection; Postoperative pain.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Amides*
  • Analgesics, Opioid / therapeutic use
  • Anesthesia, Local / methods*
  • Anesthetics, Local*
  • Double-Blind Method
  • Female
  • Hepatectomy*
  • Humans
  • Infusions, Intralesional
  • Male
  • Middle Aged
  • Morphine / therapeutic use
  • Pain Measurement
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / prevention & control*
  • Postoperative Care / methods*
  • Prospective Studies
  • Ropivacaine
  • Sodium Chloride*
  • Treatment Outcome
  • Young Adult

Substances

  • Amides
  • Analgesics, Opioid
  • Anesthetics, Local
  • Sodium Chloride
  • Morphine
  • Ropivacaine