Comparison of continuous wound infiltration analgesia with systemic analgesia in stoma closure

Objective: To compare the effectiveness of continuous wound infiltration analgesia with anesthesia using ketoprofen.

Materials and methods. The study included 92 patients aged from 18 to 82 who underwent stoma closure. Patients were randomly divided into two groups. The main group included 48 patients. The basic analgesia was the injection of Ropivacaine 0,2% – 20 ml through the intra-wound catheter 3 times a day. Ketoprofen and tramadol were added on demand depending on the severity of the pain syndrome. The control group included 42 patients. The basic analgesia was the intravenous injection of Ketoprofen – 100 mg 2 times a day, in case of uneffective tramadol 5% – 100 mg was added, up to 3 times a day.

Results. In the main group on the first, second and third days, the maximum dose of ketoprofen was used rarely than in the control group: 21(44%) versus 29(69%), p=0,028; 29(60%) vs 38(90%), p=0,0025; 22(46%) vs 29(69%), p=0,045. On the second day, the frequency of ketoprofen usage was lower in the main group than in control group: 41 (85%) versus 42 (100%), p=0,029. On the first day, tramadol was used less frequently in the main group: 5 (10%) versus 22 (52%), p<0,001. In addition, on the first day, the maximum daily dosage of tramadol was used less frequently in the main group than in control group: 2 patients (4%) versus 10 (24%) in the control group, p=0.0154. The time of activity on the second day was higher in the main group than in control group: 30(20-60) versus 15(10-30), p=0,016. The number of episodes of vomiting on the first day was less in the main group: 4 (8%) versus 12 (29%), p=0,026.

Conclusion. Continuous wound infiltration analgesia reduced the consumption of analgesic drugs, the frequency of vomiting on the first day and increased the time of patients' activity on the second day.

1. Ovechkin A.M., Bayalieva A.Zh., Ezhevskaya A.A. et al. Postoperative analgesia. Guidelines. Annals of Critical Care. 2019. 4. 9. 33. DOI: 10.21320/1818-474X-2019-4-9-33. in Russian.

2. Thangavel A.R., Sethi S., Gupta V. Comparison of Continuous Wound Infusion versus Continuous Epidural Infusion in Upper Abdominal Surgery: Noninferiority Randomized Controlled Trial. Anesth Essays Res. 2019. 13. 4. 676-682. DOI: 10.4103/aer.AER_133_19

3. Huang X.Z., Zhao J.H., Gao P. et al. Continuous Wound Infiltration with Local Anesthetic Is an Effective and Safe Postoperative Analgesic Strategy: A Meta-Analysis. Pain Ther. 2021. 10. 1. 525-538. DOI: 10.1007/s40122-021-00241-4

4. Gathege D., Abdulkarim A., Odaba D., Mugambi S. Effectiveness of Pain Control of Local Anaesthetic Wound Infusion Following Elective Midline Laparotomy: A Randomized Trial. World J Surg. 2021. 45. 7. 2100-2107. DOI: 10.1007/s00268-021-06072-w

5. Xuan C., Yan W., Wang D. et al. Efficacy of different analgesia treatments for abdominal surgery: A network meta-analysis. Eur J Pain. 2022. 26. 3. 567-577. DOI: 10.1002/ejp.1880

6. Gavriilidis P., Roberts K.J., Sutcliffe R.P. Local anaesthetic infiltration via wound catheter versus epidural analgesia in open hepatectomy: a systematic review and meta-analysis of randomised controlled trials. HPB (Oxford). 2019. 21. 8. 945-952. DOI: 10.1016/j.hpb.2019.02.007

7. Ventham N.T., Hughes M., O'Neill S. et al. Systematic review and meta-analysis of continuous local anaesthetic wound infiltration versus epidural analgesia for postoperative pain following abdominal surgery. Br J Surg. 2013. 100. 10. 1280-9. DOI: 10.1002/bjs.9204

8. Grape S., Kirkham K.R., Akiki L., Albrecht E. Transversus abdominis plane block versus local anesthetic wound infiltration for optimal analgesia after laparoscopic cholecystectomy: A systematic review and meta-analysis with trial sequential analysis. J Clin Anesth. 2021. 75. 110450. DOI: 10.1016/j.jclinane.2021.110450

9. Lee N.H., Ryu K., Song T. Postoperative analgesic efficacy of continuous wound infusion with local anesthetics after laparoscopy (PAIN): a randomized, double-blind, placebo-controlled trial. Surgical Endoscopy. 2021. 35. 562-568. DOI: 10.1007/s00464-020-07416-8

10. Salama E.R. Post-operative bilateral continuous ultrasound-guided transversus abdominis plane block versus continuous local anaesthetic wound infusion in patients undergoing abdominoplasty. Indian J Anaesth. 2018. 62. 6. 449-454. DOI: 10.4103/ija.IJA_221_18

11. Chandon M., Bonnet A., Burg Y. et al. Ultrasound-guided Transversus Abdominis plane block versus continuous wound infusion for post-caesarean analgesia: a randomized trial. PLoS One. 2014. 9. 8. e103971. DOI: 10.1371/journal.pone.0103971

12. Vinokurova А.А., Rudnov V.А., Dubrovin S.G. Analgesia of post-operative wound with local anesthetics. Messenger of Anesthesiology and Resuscitation. 2019. 16. 4. 47-55. DOI: 10.21292/2078-5658-2019-16-4-47-55. in Russian.

13. Timerbulatov S.V., Timerbulatov M.V., Yagafarov A.K. Continuous local anesthetic infusion in the postoperative period. Bashkortostan Medical Journal. 2019. 14 (2). 80-87. in Russian.