Efficacy Of Wound Analgesia For Postoperative Pain Control
Ales Klvacek, Jakub Konecny, Vladimir Lonsky, Petr Santavy.
University Hospital Olomouc, Olomouc, Czech Republic.
Objectives: Continuous wound infusion of local anesthetics has been successfully applied for postoperative pain control in several procedures but, surprisingly, it is underused in cardiothoracic surgery. We aimed to investigace the effects of woung analgesia associated with systemic patient-controlled analgesia in patients undergoing myocardial revacularization from left anterior small thoracotomy (i.e. MIDCAB).
Methods: Fourty-two consecutive patients undregoing myocardial revascularization via left anterior small thoracotomy were randomized into two groups (wound analgesia and systemic patient-controlled analgesia). Bupivacaine in the wound group was injected using a multiholed catheter connected to an elastomeric pump inserted at the end of the operation above the intercostal muscles and removed 48 h after. The inter group differences were assessed by following kriteria: pain on visual analogue scale at rest, narcotic and NSAID medication consumption at different time point sof the postoperative course.
Results: All fourty-two patients were included into the analysis. Thus, the wound and systemic analgesia groups comprised 22 and 20 patients, respectively. The wound group analgesia compared with the systemic analgesia group had a signifiant decrease of pain scores at rest (p˂0,001) and reduction of additional piritramidum (p˂ 0,002) and metamizole(p˂0,003) intake during the entire postoperative course.
Conclusions: Our data prove that wound analgesia is an effective, easy and save procedure. It significantly reduces pain scores and analgetik medication intake. Cathter placement does not require particular manoeures by the surgeon nor does the elastomeric pump need any adjustment or care of physicians or nurses.
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