C Groeger1,2, M Schomaker3,4, W Raue5,6, J Pratschke5,6, O Haase5,6. 1. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. christian.groeger@charite.de. 2. Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. christian.groeger@charite.de. 3. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. martin.schomaker@charite.de. 4. Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. martin.schomaker@charite.de. 5. Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. 6. Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
Abstract
BACKGROUND: Continuous application of local anaesthetics reduces postoperative pain after different approaches for laparotomy. In this randomized, blinded trial, we investigated the effect of continuous application of local anaesthetics after paramedian laparotomy either with subfascial or subcutaneous catheter in addition to a standardized systemic analgesia. MATERIALS AND METHODS: Patients with stage III/IV melanoma and indication for radical iliac lymph node dissection (RILND) were randomized to a continuous application of a local anaesthetic through either a subfascial or subcutaneous catheter. Participants and those assessing the outcomes were blinded. The main outcome criterion was the pain level on the first postoperative morning while exercising measured with a visual analogue scale. Minor criteria were the pain measured by the area-under-curve until the third postoperative day, the patient's satisfaction with analgesic treatment, the analgesic requirement, the overall complications and the day of discharge. RESULTS: Fifty-two patients were evaluated. Pain therapy was sufficient in both groups during the postoperative course while resting and during mobilization. There were no significant differences regarding the main and minor outcome criteria. Doses of additional analgesics did not differ between groups. No adverse events or side effects were observed. CONCLUSION: For patients who undergo paramedian laparotomy, none of the investigated techniques is superior to the other at a median pain level under visual analogue scale (VAS) 30 mm on the first postoperative morning. TRIAL REGISTRATION NUMBER: DRKS00003632 (German Register of Clinical Trials).
RCT Entities:
BACKGROUND: Continuous application of local anaesthetics reduces postoperative pain after different approaches for laparotomy. In this randomized, blinded trial, we investigated the effect of continuous application of local anaesthetics after paramedian laparotomy either with subfascial or subcutaneous catheter in addition to a standardized systemic analgesia. MATERIALS AND METHODS:Patients with stage III/IV melanoma and indication for radical iliac lymph node dissection (RILND) were randomized to a continuous application of a local anaesthetic through either a subfascial or subcutaneous catheter. Participants and those assessing the outcomes were blinded. The main outcome criterion was the pain level on the first postoperative morning while exercising measured with a visual analogue scale. Minor criteria were the pain measured by the area-under-curve until the third postoperative day, the patient's satisfaction with analgesic treatment, the analgesic requirement, the overall complications and the day of discharge. RESULTS: Fifty-two patients were evaluated. Pain therapy was sufficient in both groups during the postoperative course while resting and during mobilization. There were no significant differences regarding the main and minor outcome criteria. Doses of additional analgesics did not differ between groups. No adverse events or side effects were observed. CONCLUSION: For patients who undergo paramedian laparotomy, none of the investigated techniques is superior to the other at a median pain level under visual analogue scale (VAS) 30 mm on the first postoperative morning. TRIAL REGISTRATION NUMBER: DRKS00003632 (German Register of Clinical Trials).
Authors: Annette Pflugfelder; Corinna Kochs; Andreas Blum; Marcus Capellaro; Christina Czeschik; Therese Dettenborn; Dorothee Dill; Edgar Dippel; Thomas Eigentler; Petra Feyer; Markus Follmann; Bernhard Frerich; Maria-Katharina Ganten; Jan Gärtner; Ralf Gutzmer; Jessica Hassel; Axel Hauschild; Peter Hohenberger; Jutta Hübner; Martin Kaatz; Ulrich R Kleeberg; Oliver Kölbl; Rolf-Dieter Kortmann; Albrecht Krause-Bergmann; Peter Kurschat; Ulrike Leiter; Hartmut Link; Carmen Loquai; Christoph Löser; Andreas Mackensen; Friedegund Meier; Peter Mohr; Matthias Möhrle; Dorothee Nashan; Sven Reske; Christian Rose; Christian Sander; Imke Satzger; Meinhard Schiller; Heinz-Peter Schlemmer; Gerhard Strittmatter; Cord Sunderkötter; Lothar Swoboda; Uwe Trefzer; Raymond Voltz; Dirk Vordermark; Michael Weichenthal; Andreas Werner; Simone Wesselmann; Ansgar J Weyergraf; Wolfgang Wick; Claus Garbe; Dirk Schadendorf Journal: J Dtsch Dermatol Ges Date: 2013-08 Impact factor: 5.584
Authors: Jonathan Lissauer; Kenneth Mancuso; Christopher Merritt; Amit Prabhakar; Alan David Kaye; Richard D Urman Journal: Best Pract Res Clin Anaesthesiol Date: 2014-05-09
Authors: Hans J Gerbershagen; Sanjay Aduckathil; Albert J M van Wijck; Linda M Peelen; Cor J Kalkman; Winfried Meissner Journal: Anesthesiology Date: 2013-04 Impact factor: 7.892