Continuous Wound Infiltration of Local Anesthetics in Postoperative Pain Management: Safety, Efficacy and Current Perspectives

Abstract

Giuseppe Paladini,1 Stefano Di Carlo,2 Giuseppe Musella,1 Emiliano Petrucci,3 Paolo Scimia,4 Andrea Ambrosoli,1 Vincenza Cofini,5 Pierfrancesco Fusco3 1Department of Anesthesia, Perioperative Medicine and Intensive Care Therapy, Filippo Del Ponte Women and Children’s Hospital, ASST Sette Laghi, Varese, Italy; 2Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Chieti, Italy; 3Department of Anesthesia and Intensive Care, San Salvatore Academic Hospital of L’Aquila, L’Aquila, Italy; 4Department of Anesthesia and Intensive Care, ASUR Marche AV5, San Benedetto Del Tronto, Italy; 5Department of Life, Health and Environmental Sciences, University of L’Aquila, L’Aquila, ItalyCorrespondence: Giuseppe PaladiniDepartment of Anesthesia, Perioperative Medicine and Intensive Care Therapy, Filippo Del Ponte Women and Children’s Hospital, ASST Sette Laghi, Via F. Del Ponte 19, Varese CAP 21100, ItalyTel [phone]Fax [phone]Email [email protected]: Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patient-controlled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.Keywords: continuous wound infiltration, postoperative analgesia, postoperative pain management, local anesthetics

Keywords

• continuous wound infiltration
• postoperative analgesia
• postoperative pain management
• local anesthetics