Efficacy of local anaesthetic infiltration via wound catheters after open hepatic surgery: a systematic review and meta-analysis.

Abstract

BACKGROUND:

This study analysed whether local anaesthetic wound catheter infiltration (LA-WCI) as an adjunct to intravenous patient-controlled analgesia (IV-PCA) provides superior outcomes compared to IV-PCA alone following liver resection.

METHODS:

A systematic review and meta-analysis was conducted for randomised control trials (RCTs) comparing LA-WCI with IV-PCA(LA-WCI group) versus IV-PCA alone (IV-PCA group). PubMed and the Cochrane Library were searched for relevant articles.

RESULTS:

Six RCTs with a total of 440 patients were included. Opioid use in the initial 48 h was less in the LA-WCI group [MD -21.27 mg (-39.39,-3.15), p = 0.02]. Pain scores were lower in the LA-WCI group at rest at POD0 (post-operative day 0)6-8 h (p = 0.0009), POD1AM(p = 0.01), POD1PM(p = 0.02) and POD2 (p = 0.0006), and exertion at POD0 0-2 h (p = 0.05), POD1AM(p = 0.03), POD1PM(p = 0.03), POD2 (p = 0.03) and POD3 (p = 0.01). LA-WCI group had reduced length of hospital stay [MD -1.32 days (-2.23,-0.40),p = 0.005], time to ambulation [MD -5.94 h (-8.47,-3.42),p = 0.00001] and incidence of nausea and vomiting (PONV) [OR 0.17 (0.07,0.43),p = 0.0002]. No differences were observed in length of intensive care unit (ICU) stay or incidence of surgical site infections.

DISCUSSION:

LA-WCI as an adjunct to opiate IV-PCA post-hepatectomy reduces opioid use, pain scores at multiple time points at rest and exertion, length of hospital stay, time to ambulation and PONV. However, LA-WCI use does not alter length of ICU stay or incidence of wound infection.

• Authors: Hatem Sadik, Naomi Watson, Nafi Dilaver, Isabella Reccia, James Cuell, Madhava Pai, Robert P Sutcliffe, Behrad Baharlo
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 25 Issue 1 Pg. 1-13 (01 2023) ISSN: 1477-2574 [Electronic] England
• PMID: 36347769 (Publication Type: Meta-Analysis, Systematic Review, Journal Article, Review)
• Copyright: Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Anesthetics, Local
• Analgesics, Opioid

Topics

• Humans
• Anesthetics, Local (adverse effects)
• Analgesics, Opioid (therapeutic use)
• Pain, Postoperative (diagnosis, etiology, prevention & control)
• Postoperative Nausea and Vomiting (complications)
• Catheters (adverse effects)
• Liver (surgery)