Paladini Giuseppe, Di Carlo Stefano, Musella Giuseppe, Petrucci Emiliano, Scimia Paolo, Ambrosoli Andrea, Cofini Vincenza, Fusco Pierfrancesco
Department of Anesthesia, Perioperative Medicine and Intensive Care Therapy, Filippo Del Ponte Women and Children's Hospital, ASST Sette Laghi, Varese, Italy.
Department of Medical, Oral and Biotechnological Sciences, University of Chieti, Chieti, Italy.
J Pain Res. 2020 Jan 31;13:285-294. doi: 10.2147/JPR.S211234. eCollection 2020.
Local infiltration and continuous infusion of surgical wound with anesthetics are parts of multimodal analgesia for postoperative pain control. The techniques, given the simplicity of execution that does not increase the timing of the intervention and does not require additional technical skills, are applied in several kinds of surgeries. The continuous wound infiltration can be used for days and a variety of continuous delivery methods can be chosen, including patient-controlled analgesia, continuous infusion or intermittent bolus. The purpose of this narrative review is to analyze the literature, in particular by researching the safety, efficacy and current perspectives of continuous wound infiltration for postoperative pain management in different surgical settings. We have identified 203 articles and 95 of these have been taken into consideration: 17 for the lower limb surgery; 7 for the upper limb surgery, 51 for the laparotomy/laparoscopic surgery of the abdominopelvic area, 13 studies regarding breast surgery and 7 for cardiothoracic surgery. The analysis of these studies reveals that the technique has a variable effectiveness based on the type of structure involved: it is better in structures rich in subcutaneous and connective tissue, while the effectiveness is limited in anatomic districts with a greater variability of innervation. However, regardless the heterogeneity of results, a general reduction in pain intensity and in opioid consumption has been observed with continuous wound infiltration: it is an excellent analgesic technique that can be included in the multimodal treatment of postoperative pain or represents a valid alternative when other options are contraindicated.
局部浸润麻醉和手术切口持续输注麻醉剂是术后疼痛控制多模式镇痛的组成部分。鉴于这些技术实施简单，既不增加手术时间，也不需要额外的技术技能，因此在多种手术中都有应用。持续伤口浸润可使用数天，并且可以选择多种持续给药方法，包括患者自控镇痛、持续输注或间歇性推注。本叙述性综述的目的是分析文献，特别是通过研究持续伤口浸润在不同手术环境中用于术后疼痛管理的安全性、有效性和当前观点。我们共检索到203篇文章，其中95篇被纳入研究：17篇关于下肢手术；7篇关于上肢手术；51篇关于腹盆腔区域的剖腹术/腹腔镜手术；13项关于乳腺手术的研究；7项关于心胸外科手术的研究。对这些研究的分析表明，该技术的有效性因所涉及的组织类型而异：在富含皮下组织和结缔组织的结构中效果更好，而在神经支配变化较大的解剖区域效果有限。然而，尽管结果存在异质性，但持续伤口浸润已观察到疼痛强度和阿片类药物消耗量普遍降低：它是一种优秀的镇痛技术，可纳入术后疼痛的多模式治疗中，或者在其他选择禁忌时作为一种有效的替代方法。
