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Novel local anesthetic wound infiltration techniques for pain after colorectal resection surgery

The latest issue of the Diseases of the Colon & Rectum evaluates novel local anesthetic wound infiltration techniques for postoperative pain following colorectal resection surgery.

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Novel local anesthetic blocks have become increasingly popular in the multimodal pain management following abdominal surgery, but have not been evaluated in a procedure-specific manner in colorectal surgery.

Dr Nicholas Ventham and colleagues evaluated the efficacy of novel local anesthetic techniques in colorectal surgery.

The team performed an electronic literature search of PubMed, EMBASE, and Cochrane databases from 1990 to 2013.

The research team identified randomized controlled trials comparing a novel local anesthetic technique with placebo/routine analgesia in adults undergoing open or laparoscopic colonic or rectal resection.

The team performed a meta-analysis of randomized controlled trials evaluating novel local anesthetic wound infiltration techniques such as wound catheter, transversus abdominis plane block, and intraperitoneal instillation in colorectal surgical procedures.

The comparator group was defined as placebo/routine analgesia.

Local anesthetics showed a reduction in opiate requirement at 48 hours
Diseases of the Colon & Rectum

The researchers' primary outcome was opiate requirement at 24 hours.

Secondary outcomes included opiate requirements at 48 hours, pain numerical rating score at 24 and 48 hours at rest and on movement, recovery, and complications.

Subgroup analysis was performed to evaluate specific local anesthetic techniques and open and laparoscopic surgery.

The team identified 12 randomized controlled trials compared local anesthetic techniques with placebo/routine analgesia.

Local anesthetic techniques demonstrated a significant reduction in opiate requirement at 48 hours.

The researchers found that local anesthetic techniques were also associated with lower pain scores on movement at 24 and 48 hours, shorter length of stay, and earlier resumption of diet.

Dr Ventham's team concludes, "Novel local anesthetic wound infiltration techniques in colorectal surgery appear to reduce opiate requirements, to reduce pain scores, and to improve recovery in comparison with placebo/routine analgesia."

Dis Colon Rectum 2014: 57(2): 237–250
17 February 2014

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