Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy.
AIM
To prospectively evaluate the effectiveness and safety of continuous wound infiltration (CWI) for pain management after open gastrectomy.


METHODS
Seventy-five adult patients with American Society of Anesthesiologists (ASA) Physical Status Classification System (ASA) grade 1-3 undergoing open gastrectomy were randomized to three groups. Group 1 patients received CWI with 0.3% ropivacaine (group CWI). Group 2 patients received 0.5 mg/mL morphine intravenously by a patient-controlled analgesia pump (PCIA) (group PCIA). Group 3 patients received epidural analgesia (EA) with 0.12% ropivacaine and 20 µg/mL morphine with an infusion at 6-8 mL/h for 48 h (group EA). A standard general anesthetic technique was used for all three groups. Rescue analgesia (2 mg bolus of morphine, intravenous) was given when the visual analogue scale (VAS) score was ≥ 4. The outcomes measured over 48 h after the operation were VAS scores both at rest and during mobilization, total morphine consumption, relative side effects, and basic vital signs. Further results including time to extubation, recovery of bowel function, surgical wound healing, mean length of hospitalization after surgery, and the patient's satisfaction were also recorded.


RESULTS
All three groups had similar VAS scores during the first 48 h after surgery. Group CWI and group EA, compared with group PCIA, had lower morphine consumption (P < 0.001), less postoperative nausea and vomiting (1.20 ± 0.41 vs 1.96 ± 0.67, 1.32 ± 0.56 vs 1.96 ± 0.67, respectively, P < 0.001), earlier extubation (16.56 ± 5.24 min vs 19.76 ± 5.75 min, P < 0.05, 15.48 ± 4.59 min vs 19.76 ± 5.75 min, P < 0.01), and earlier recovery of bowel function (2.96 ± 1.17 d vs 3.60 ± 1.04 d, 2.80 ± 1.38 d vs 3.60 ± 1.04 d, respectively, P < 0.05). The mean length of hospitalization after surgery was reduced in groups CWI (8.20 ± 2.58 d vs 10.08 ± 3.15 d, P < 0.05) and EA (7.96 ± 2.30 d vs 10.08 ± 3.15 d, P < 0.01) compared with group PCIA. All three groups had similar patient satisfaction and wound healing, but group PCIA was prone to higher sedation scores when compared with groups CWI and EA, especially during the first 12 h after surgery. Group EA had a lower mean arterial pressure within the first postoperative 12 h compared with the other two groups.


CONCLUSION
CWI with ropivacaine yields a satisfactory analgesic effect within the first 48 h after open gastrectomy, with lower morphine consumption and accelerated recovery.
['Zheng|Xing|X|', 'Feng|Xu|X|', 'Cai|Xiu-Jun|XJ|']
D000368:Aged D000577:Amides D015360:Analgesia, Epidural D016058:Analgesia, Patient-Controlled D000701:Analgesics, Opioid D000779:Anesthetics, Local D002681:China D004311:Double-Blind Method D005260:Female D005743:Gastrectomy D006801:Humans D007262:Infusions, Intravenous D007902:Length of Stay D008297:Male D008875:Middle Aged D009020:Morphine D059408:Pain Management D010147:Pain Measurement D010149:Pain, Postoperative D011446:Prospective Studies D020127:Recovery of Function D000077212:Ropivacaine D013997:Time Factors D016896:Treatment Outcome D014945:Wound Healing
Wound infiltration Postoperative pain Gastrectomy Ropivacaine Patient-controlled analgesia Epidural analgesia Incision infection