Thibaut Rackelboom1, Solenn Le Strat, Stephane Silvera, Thomas Schmitz, Agnes Bassot, François Goffinet, Yves Ozier, Marc Beaussier, Alexandre Mignon. 1. From Department of Anesthesiology and Intensive Care, Department of Radiology, Department of Obstetrics and Gynecology, Maternité Port-Royal, France; University Paris Descartes; Cochin University Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France; Anesthesiology and Intensive Care, Saint-Antoine University Hospital, Assistance Publique-Hôpitaux de Paris, University Pierre et Marie Curie Paris 6; Paris, France.
Abstract
OBJECTIVE: To evaluate in which anatomical layer (above the fascia or below the fascia) continuous wound infusion of local anesthetic, combined with nonsteroidal antiinflammatory drugs, through a multiorifice catheter has the best effectiveness during the first 48 hours on postoperative pain intensity after elective cesarean delivery. METHODS:Fifty-six women undergoing elective cesarean delivery under spinal anesthesia were randomly allocated to receive 48-hour continuous wound infusion either above the fascia or below the fascia using ropivacaine and ketoprofene through a multiholed wound catheter. No other systemic analgesics were used, except for rescue patient-controlled intravenous morphine. Evaluation by a blinded investigator included visual analog scale scores at rest and at movement, morphine consumption, patient satisfaction, residual pain at 1 and 6 months, and undesirable side effects. RESULTS: Continuous wound infusion below the fascia resulted in significantly reduced pain at rest and total postoperative morphine consumption (15.7 mg, 95% confidence interval 9.7-20.7 mg) compared with wound administration above the fascia (26.4 mg, 95% confidence interval 18.1-34.7). No undesirable side effects or residual pain requiring treatment were recorded in both groups, whereas analgesia and satisfaction were excellent. CONCLUSION: After cesarean delivery, continuous wound infusion over 48 hours with ropivacaine and ketoprofene through a multiholed wound catheter inserted below the fascia results in better analgesia when compared with administration above the fascia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01160913. LEVEL OF EVIDENCE: I.
RCT Entities:
OBJECTIVE: To evaluate in which anatomical layer (above the fascia or below the fascia) continuous wound infusion of local anesthetic, combined with nonsteroidal antiinflammatory drugs, through a multiorifice catheter has the best effectiveness during the first 48 hours on postoperative pain intensity after elective cesarean delivery. METHODS: Fifty-six women undergoing elective cesarean delivery under spinal anesthesia were randomly allocated to receive 48-hour continuous wound infusion either above the fascia or below the fascia using ropivacaine and ketoprofene through a multiholed wound catheter. No other systemic analgesics were used, except for rescue patient-controlled intravenous morphine. Evaluation by a blinded investigator included visual analog scale scores at rest and at movement, morphine consumption, patient satisfaction, residual pain at 1 and 6 months, and undesirable side effects. RESULTS: Continuous wound infusion below the fascia resulted in significantly reduced pain at rest and total postoperative morphine consumption (15.7 mg, 95% confidence interval 9.7-20.7 mg) compared with wound administration above the fascia (26.4 mg, 95% confidence interval 18.1-34.7). No undesirable side effects or residual pain requiring treatment were recorded in both groups, whereas analgesia and satisfaction were excellent. CONCLUSION: After cesarean delivery, continuous wound infusion over 48 hours with ropivacaine and ketoprofene through a multiholed wound catheter inserted below the fascia results in better analgesia when compared with administration above the fascia. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT01160913. LEVEL OF EVIDENCE: I.
Authors: Kelsey D Mitchell; C Tyler Smith; Courtney Mechling; Charles B Wessel; Steven Orebaugh; Grace Lim Journal: Reg Anesth Pain Med Date: 2019-10-25 Impact factor: 6.288
Authors: Girish P Joshi; Jeffrey E Janis; Eric M Haas; Bruce J Ramshaw; Mikio A Nihira; Brian J Dunkin Journal: Plast Reconstr Surg Glob Open Date: 2016-12-23