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Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double‐blind randomized, controlled trial in colorectal surgery
Author(s) -
Fustran N.,
Dalmau A.,
Ferreres E.,
Camprubí I.,
Sanzol R.,
Redondo S.,
Kreisler E.,
Biondo S.,
Sabaté A.
Publication year - 2015
Publication title -
colorectal disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.029
H-Index - 89
eISSN - 1463-1318
pISSN - 1462-8910
DOI - 10.1111/codi.12893
Subject(s) - medicine , ropivacaine , laparotomy , saline , anesthesia , laparoscopy , surgery , colorectal surgery , randomized controlled trial , morphine , interquartile range , laparoscopic surgery , abdominal surgery
Aim The aim of this prospective double‐blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion ( CWI ) of the local anaesthetic ropivacaine after either laparotomy or video‐assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine. Method Patients scheduled for colorectal surgery randomly received a 48‐h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end‐point was total morphine consumption in surgery and afterwards through a patient‐controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared. Results Sixty‐seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range ( IQR )] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25–42.75)] than in the saline group [52 mg (24.5–64)] ( P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6–34.7)] than in the saline group [52.5 (22.5–65) ml] ( P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty‐six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination. Conclusion Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.