AIM: To provide a specific review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparotomy for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a significant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a significant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91 to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local anaesthetic wound infusion was associated with a significant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no significant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic review and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major colorectal surgery is a promising technique but do not provide conclusive evidence of benefit. Further research is required including cost-effectiveness analysis.
AIM: To provide a specific review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparotomy for major colorectal surgery. METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes. RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a significant decrease in post-operative painVAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a significant reduction in painVAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91 to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local anaesthetic wound infusion was associated with a significant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no significant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45). CONCLUSION: The results of this systematic review and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major colorectal surgery is a promising technique but do not provide conclusive evidence of benefit. Further research is required including cost-effectiveness analysis.
Authors: David M Kushner; Regina LaGalbo; Joseph P Connor; Rick Chappell; Sarah L Stewart; Ellen M Hartenbach Journal: Obstet Gynecol Date: 2005-08 Impact factor: 7.661
Authors: Mirza K Baig; Oded Zmora; Jeannette Derdemezi; Eric G Weiss; Juan J Nogueras; Steven D Wexner Journal: J Am Coll Surg Date: 2006-02 Impact factor: 6.113
Authors: Adrian L Polglase; Paul J McMurrick; Paul J B Simpson; Roger J Wale; Peter W G Carne; William Johnson; Justin Chee; Corrine W Ooi; Jennifer W D Chong; Sally R Kingsland; Rachelle Buchbinder Journal: Dis Colon Rectum Date: 2007-10-03 Impact factor: 4.585
Authors: V Mann; S Mann; A Hecker; R Röhrig; M Müller; T Schwandner; M Hirschburger; A Sprengel; M A Weigand; W Padberg Journal: Chirurg Date: 2011-10 Impact factor: 0.955
Authors: A Feldheiser; O Aziz; G Baldini; B P B W Cox; K C H Fearon; L S Feldman; T J Gan; R H Kennedy; O Ljungqvist; D N Lobo; T Miller; F F Radtke; T Ruiz Garces; T Schricker; M J Scott; J K Thacker; L M Ytrebø; F Carli Journal: Acta Anaesthesiol Scand Date: 2015-10-30 Impact factor: 2.105
Authors: Sophie S Liang; Andrew J Ying; Eshan T Affan; Benedict F Kakala; Giovanni Fm Strippoli; Alan Bullingham; Helen Currow; David W Dunn; Zeigfeld Yu-Ting Yeh Journal: Cochrane Database Syst Rev Date: 2019-10-19