Postoperative Analgesia: Comparing Continuous Epidural Catheter Infusion of Local Anesthetic and Opioid and Continuous Wound Catheter Infusion of Local Anesthetic

• Published in: Revista brasileira de anestesiologia 2011-05, Vol.61 (3), p.293-303
• Main Authors: de Almeida, Maria Cristina Simões, de Figueiredo Locks, Giovani, Gomes, Horácio Pereira, Brunharo, Guilherme Muriano, Kauling, Ana Laura Colle
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analgesia, Epidural; Analgesia, Epidural - methods; Analgesia, Patient controlled; Analgesia, Patient-Controlled - methods; Analgesics, Opioid - administration & dosage; ANESTESIA, Local; Anesthesia, Local; Anesthetics, Local - administration & dosage; Catheterization; DOLOR: Postoperatorio; DOR: Pós-operatória; EQUIPAMENTO: Cateter peridural; EQUIPO: Cateter peridural; Female; Humans; Male; Middle Aged; Pain, Postoperative; Pain, Postoperative - prevention & control; Prospective Studies; TÉCNICAS DE ANALGESIA: PCA Analgesia controlada pelo paciente; TÉCNICAS DE ANALGESIA: PCA Analgesia controlada por el paciente; Wounds and Injuries; Young Adult
• ISSN: 0034-7094; 1806-907X
• DOI: 10.1016/S0034-7094(11)70035-6

Continuous wound infusion has been investigated as a method of postoperative pain control and its efficacy has been demonstrated when compared to saline infusion. The objective of this study was to compare the quality of postoperative analgesia, the use of opioids as rescue analgesia, patient satisfaction, and the incidence of complications between epidural catheter infusion of local anesthetic and opioids and continuous wound infusion of local anesthetic. Thirty-eight patients undergoing elective laparotomy under general anesthesia, randomly divided into two groups, participated in this study. Group I (GI) received postoperative patient-controlled epidural analgesia (PCEA) with continuous infusion of ropivacaine and fentanyl, while Group II (GII) receive postoperative patient-controlled continuous wound catheter infusion of ropivacaine. In the postoperative period, the following parameters were assessed: quality of analgesia through the Visual Analogue Scale; use of rescue opioids; and adverse effects driving patient satisfaction. Decreased pain at rest and with movements (p < 0.05) and lower consumption of rescue opioids (p < 0.05) were observed in GI in all intervals evaluated, as well as greater patient satisfaction in the post anesthesia care unit (PACU). The incidence of complications was similar in both groups except for pruritus which prevailed in GI between 6 (p < 0.05) and 24 (p < 0.001) postoperative hours. Postoperative analgesia with opioids and local anesthetics via PCEA was superior to the patient-controlled local anesthetic infusion into surgical wound. The incidence of side effects was similar in both groups. A infusão contínua de anestésicos locais na ferida cirúrgica vem sendo investigada como um método no controle da dor pós-operatória, tendo sido demonstrada sua eficácia em relação à infusão de solução fisiológica. O objetivo deste estudo foi comparar a qualidade da analgesia pós-operatória, o uso de opioides como analgesia de resgate, a satisfação dos pacientes e a incidência de complicações entre a utilização de anestésico local e opioide via cateter peridural, com a infusão contínua de anestésico local na ferida operatória. Foram selecionados 38 pacientes submetidos a laparotomias eletivas sob anestesia geral, que foram distribuídos aleatoriamente em dois grupos. O Grupo I recebeu como analgesia pós-operatória ropivacaína e fentanil em infusão contínua e controlada pelo paciente por cateter peridural (PCEA), enquanto o Grupo II, rec