Anesthesiology and Critical Care Research Center Shiraz University of Medical Sciences, Shiraz, Iran.
Pain Res Manag. 2024 Jul 22;2024:2357709. doi: 10.1155/2024/2357709. eCollection 2024.
The effectiveness of continuous wound infiltration (CWI) as a postoperative pain-control technique has been shown in many surgical procedures. This study investigates the effect of CWI of local anesthetic on postoperative pain control in intertrochanteric fracture patients undergoing hip nailing surgery.
In this randomized clinical trial, 48 patients who were scheduled for hip nailing surgery were randomly assigned to receive ( = 24) or not receive ( = 24) bupivacaine infusion through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), required dose of morphine, and drug-related complications within 24 hours of the intervention were assessed and compared.
Pain intensity was significantly lower in the bupivacaine group both during the recovery room stay and in the ward in the first 24 hours after the procedure ( < 0.001). In the recovery room, the control group patients had a higher morphine consumption compared to the bupivacaine group ( < 0.001) and requested it earlier than the bupivacaine group (60 (45-60) vs. 360 (195-480) minutes) ( < 0.001). In the ward, all control group patients used the PCA morphine pump, while only 54% of the bupivacaine group self-administered morphine through the pump, with a significantly lower total morphine consumption (1 (0-2) vs. 10 (5-14) mg, < 0.001). None of the patients in the bupivacaine group required additional morphine, while 37.5% of the control requested additional morphine (=0.002). Altogether, the control group had a higher total morphine consumption compared to the bupivacaine group in the first 24 hours (10.5 (6-15.5) vs. 1 (0-2) mg, < 0.001).
CWI of bupivacaine helps better pain reduction during the early postoperative hours while it reduces opioid consumption, minimizes nausea and vomiting, and improves patient satisfaction.
持续伤口浸润（CWI）作为一种术后止痛技术，已在许多外科手术中得到证实。本研究旨在探讨局部麻醉药 CWI 对接受髋钉钉手术的股骨转子间骨折患者术后疼痛控制的影响。
这是一项随机临床试验，48 名计划接受髋钉钉手术的患者被随机分为接受（n=24）或不接受（n=24）布比卡因输注组，术后通过手术伤口内的导管输注。评估并比较两组患者在干预后 24 小时内的疼痛强度（NRS）、吗啡所需剂量和药物相关并发症。
在恢复室和术后 24 小时内，布比卡因组的疼痛强度均显著低于对照组（<0.001）。在恢复室，与布比卡因组相比，对照组患者吗啡消耗量更高（<0.001），且要求使用吗啡的时间更早（60（45-60）比 360（195-480）分钟）（<0.001）。在病房中，所有对照组患者均使用 PCA 吗啡泵，而只有 54%的布比卡因组患者通过泵自行给予吗啡，吗啡总消耗量明显较低（1（0-2）比 10（5-14）mg，<0.001）。布比卡因组无患者需要额外吗啡，而对照组有 37.5%的患者需要（=0.002）。总的来说，与布比卡因组相比，对照组患者在术后 24 小时内吗啡总消耗量更高（10.5（6-15.5）比 1（0-2）mg，<0.001）。
布比卡因 CWI 有助于在术后早期更好地减轻疼痛，同时减少阿片类药物的消耗，减少恶心和呕吐，并提高患者满意度。
