Department of Anaesthesiology and Intensive Care, Örebro University Hospital, Örebro, Sweden.
Curr Opin Anaesthesiol. 2010 Dec;23(6):708-13. doi: 10.1097/ACO.0b013e32833f0dd7.
Wound infiltration analgesia using local anaesthetics has been used for several decades. Recently, newer techniques to prolong analgesia have developed, including the use of catheters and injection of local anaesthetics or other adjuvants, and local infiltration analgesia using large volumes of local anaesthetics injected into different tissue planes. The aim of this review is to present the current status of wound infiltration analgesia in management of postoperative pain and to highlight the risks of this technique in clinical practice.
Several studies have shown beneficial effects of local anaesthetics, with or without adjuvant drugs, in the management of postoperative pain. Specifically, the use of local anaesthetics injected via catheters to prolong analgesia reduces postoperative pain, albeit to a limited extent. The use of large volumes of local anaesthetics into tissue planes during surgery is also beneficial in pain management. Single doses of local anaesthetics provide pain relief, but the short duration of effect can be a limiting factor. There is a growing concern about some side-effects associated with the use of local anaesthetics, specifically toxicity when drugs are injected in large doses, chondrotoxicity when bupivacaine is injected intra-articularly in higher concentrations and over a period and finally, infection when using catheters that are retained in situ.
Used correctly and in adequate doses, wound infiltration analgesia can be used in a multimodal analgesic regime without major complications. It offers the benefit of providing analgesia at a low cost when used as a single injection.
局部麻醉药浸润镇痛已应用数十年。近年来，为了延长镇痛时间，出现了一些新技术，包括使用导管和注射局部麻醉药或其他佐剂，以及将大体积的局部麻醉药注入不同组织平面进行局部浸润镇痛。本文旨在介绍局部浸润镇痛在术后疼痛管理中的现状，并强调该技术在临床实践中的风险。
几项研究表明，局部麻醉药（单独或联合佐剂）在术后疼痛管理中有有益作用。具体来说，通过导管注射延长镇痛时间的局部麻醉药可以减轻术后疼痛，但程度有限。手术中在组织平面注入大体积的局部麻醉药也有利于疼痛管理。单次剂量的局部麻醉药可以缓解疼痛，但作用持续时间短可能是一个限制因素。人们越来越关注与局部麻醉药使用相关的一些副作用，特别是大剂量注射药物时的毒性、高浓度布比卡因关节内注射时的软骨毒性以及留置导管时的感染。
正确且适量使用局部浸润镇痛可与多模式镇痛方案联合使用，无重大并发症。与单次注射相比，其优势在于低成本提供镇痛。
