Wound infusion with local anaesthesia after laparotomy: a randomized controlled trial

Area of Science:

• Anesthesiology
• Surgical Recovery
• Pain Management

Background:

• Post-laparotomy pain management often relies on systemic opioids, potentially delaying recovery.
• Continuous local anesthesia infusion may offer an alternative to reduce opioid dependence and improve surgical outcomes.

Purpose of the Study:

• To evaluate the efficacy of continuous wound infiltration with ropivacaine versus saline for post-laparotomy analgesia.
• To assess the impact of ropivacaine infusion on opioid requirements, bowel function, mobilization, and hospital stay.

Main Methods:

• A double-blinded, randomized controlled trial involving 55 patients undergoing laparotomy.
• Patients received continuous infusion of 0.2% ropivacaine or normal saline into the fascial plane of the abdominal wound.
• Outcomes included opioid consumption, time to first flatus and bowel movement, independent ambulation, hospital length of stay, and pain scores.

Main Results:

• Ropivacaine group showed significantly reduced morphine requirements at 48 hours (P=0.01).
• Patients receiving ropivacaine experienced earlier mobilization (P=0.02) and first flatus (P=0.02), with reduced post-operative ileus (P=0.02).
• No significant differences were observed in time to first bowel movement or length of hospital stay.

Conclusions:

• Continuous fascial plane local anesthesia with ropivacaine provides effective analgesia after laparotomy.
• This method enhances patient recovery by promoting earlier return of bowel function and improved mobility.