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Evaluation of Novel Local Anesthetic Wound Infiltration Techniques for Postoperative Pain Following Colorectal Resection Surgery: A Meta-analysis

Ventham, Nicholas T. M.R.C.S.(Engl.), M.B.B.S.; O’Neill, Stephen M.R.C.S.(Edinb.), M.B.Ch.B.; Johns, Neil M.R.C.S.(Edinb.), M.B.B.S.; Brady, Richard R. M.D., M.R.C.S.(Edinb.), M.B.Ch.B.; Fearon, Kenneth C. H. M.D., F.R.C.S.(Glasg., Edinb., Engl.)

doi: 10.1097/DCR.0000000000000006
Original Contributions: Current Status

BACKGROUND: 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.

OBJECTIVE: This study aims to evaluate the efficacy of novel local anesthetic techniques in colorectal surgery.

DATA SOURCES: Electronic literature search of PubMed, EMBASE, and Cochrane databases (date range, January 1990 to February 2013)

STUDY SELECTION: Randomized controlled trials comparing a novel local anesthetic technique with placebo/routine analgesia in adults undergoing open or laparoscopic colonic or rectal resection were selected.

INTERVENTIONS: This is 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.

OUTCOME MEASURES: The 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 (length of stay, nausea and vomiting, time until bowel movement and diet resumption), and complications. Subgroup analysis was performed to evaluate specific local anesthetic techniques and open and laparoscopic surgery.

RESULTS: Twelve randomized controlled trials compared local anesthetic techniques with placebo/routine analgesia. Local anesthetic techniques demonstrated a significant reduction in opiate requirement at 48 hours. 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.

LIMITATIONS: The diverse study design led to statistical heterogeneity in several analyses.

CONCLUSIONS: 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.

Department of Colorectal Surgery, Western General Hospital, Edinburgh, United Kingdom

Financial Disclosure: None reported.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML and PDF versions of this article on the journal’s Web site (www.dcrjournal.com).

Correspondence: Nicholas T. Ventham, M.R.C.S.(Engl.), M.B.B.S., Department of Colorectal Surgery, Western General Hospital, Crewe Road South, Edinburgh, EH4 2XU, UK. E-mail: n.ventham@doctors.org.uk

© 2014 The American Society of Colon and Rectal Surgeons