Prospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 7, 2016; 22(5): 1902-1910
Published online Feb 7, 2016. doi: 10.3748/wjg.v22.i5.1902
Effectiveness and safety of continuous wound infiltration for postoperative pain management after open gastrectomy
Xing Zheng, Xu Feng, Xiu-Jun Cai
Xing Zheng, Department of Anesthesiology, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou 310016, Zhejiang Province, China
Xu Feng, Xiu-Jun Cai, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, Hangzhou 310016, Zhejiang Province, China
Author contributions: Zheng X designed the research and drafted the manuscript; Feng X collected data and performed statistical analysis; Cai XJ supervised the research and revised the manuscript.
Supported by Foundation of Health Department of Zhejiang Province, China, No. 2011RCA207; and Foundation of Education Department of Zhejiang Province, China, No. Y201431914.
Institutional review board statement: The study was reviewed and approved by the Institutional Review Board and Ethics Committee of Sir Run Run Shaw Hospital, Hangzhou, China.
Clinical trial registration statement: We applied for waiver of the clinical trial registration.
Informed consent statement: All study participants, or their legal guardian, provided written informed consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that there is no conflict of interest related to this study.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Xiu-Jun Cai, PhD, Professor, Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University, School of Medicine, No. 3 Qingchun East Road, Hangzhou 310016, Zhejiang Province, China. cxjzu@hotmail.com
Telephone: +86-571-86090073 Fax: +86-571-86044817
Received: May 13, 2015
Peer-review started: May 19, 2015
First decision: September 29, 2015
Revised: October 28, 2015
Accepted: November 19, 2015
Article in press: November 19, 2015
Published online: February 7, 2016
Abstract

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.

Keywords: Postoperative pain, Gastrectomy, Wound infiltration, Epidural analgesia, Patient-controlled analgesia, Incision infection, Ropivacaine

Core tip: This prospective study compared the analgesic effectiveness and safety of continuous wound infiltration (CWI) with ropivacaine after open gastrectomy with epidural analgesia and patient-controlled intravenous analgesia. CWI could provide similar analgesia compared with epidural analgesia and patient-controlled intravenous analgesia within the first 48 h after surgery, but with lower morphine consumption, fewer side effects, and an accelerated early recovery. These results suggest that CWI with local anesthetics could be a suitable option for postoperative pain management after major abdominal surgery.