Objective: To evaluate the effectiveness of incisional infusion through local anesthetics under a continuous-infusion elastomeric pump for the management of postoperative pain after laparotomy, on reducing the amount of opioids being used after surgery.
Methods: We performed a retrospective comparative analysis on 285 patients who had undergone laparotomies between January 2012 and September 2012. Among those patients, 144 took a continuous-infusion elastomeric pump to receive local anesthetic (LA) at the incisional area for postoperative pain management while another 141 patients took 'patient-controlled' intravenous analgesia (PCA). Data were reviewed on items as:visual analog pain scores (VAS) during both resting and active situation, mean opioid use, bowel function, condition of incision and complications etc.
Results: Both groups showed similar VAS scores for the first 48 hours post-operation. However, in the LA group,VAS scores appeared significantly higher within the first 72 hours (P < 0.001), with less opioid use (P < 0.01), less symptoms as postoperative nausea or vomiting (P < 0.001), with earlier recovery of bowel function (P < 0.01) etc. when compared to the PCA group. No significant difference found on the incidence rates of wound infection other than, a higher rate of incisional drainage (P < 0.001) was seen in the LA group.
Conclusion: Continuous infusion of local anesthetic under an elastomeric infusion pump post the laparotomy, a similar analgesic effect could be seen on those patient-controlled intravenous analgesia within the first 48 hours, it could also reduce opioid consumption and postoperative symptoms as nausea or vomiting, which all appeared to be associated with the earlier recovery of bowel function.