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World J Gastroenterol. Sep 14, 2008; 14(34): 5301-5305
Published online Sep 14, 2008. doi: 10.3748/wjg.14.5301
Continuous wound infusion of local anaesthetic agents following colorectal surgery: Systematic review and meta-analysis
Alan Karthikesalingam, Stewart R Walsh, Sheraz R Markar, Umar Sadat, Tjun Y Tang, Charles M Malata
Alan Karthikesalingam, Stewart R Walsh, Sheraz R Markar, Umar Sadat, Tjun Y Tang, Department of General Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 2QQ, United Kingdom
Charles M Malata, Department of Plastic and Reconstructive Surgery, Addenbrooke’s Hospital, Cambridge University Hospi-tals Foundation Trust, Cambridge CB2 2QQ, United Kingdom
Author contributions: Karthikesalingam A and Malata CM designed research; Karthikesalingam A, Markar SR, Walsh SR and Sadat U performed research; Walsh SR, Tang TY and Sadat U analysed data; and Karthikesalingam A, Walsh SR, Sadat U, Markar SR and Malata CM wrote the paper.
Correspondence to: Stewart R Walsh, Department of General Surgery, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Specialist Registrar in General Surgery, Box 201, Level 7, Hills Road, Cambridge CB2 2QQ, United Kingdom. srwalsh@doctors.org.uk
Telephone: +44-1223-217246 Fax: +44-1223-216015
Received: May 25, 2008
Revised: July 3, 2008
Accepted: July 10, 2008
Published online: September 14, 2008
Abstract

AIM: To provide a specific review and meta-analysis of the available evidence for continuous wound infusion of local anaesthetic agents following midline laparotomy for major colorectal surgery.

METHODS: Medline, Embase, trial registries, conference proceedings and article reference lists were searched to identify randomised, controlled trials of continuous wound infusion of local anaesthetic agents following colorectal surgery. The primary outcomes were opioid consumption, pain visual analogue scores (VASs), return to bowel function and length of hospital stay. Weighted mean difference were calculated for continuous outcomes.

RESULTS: Five trials containing 542 laparotomy wounds were eligible for inclusion. There was a significant decrease in post-operative pain VAS at rest on day 3 (weighted mean difference: -0.43; 95% CI: -0.81 to -0.04; P = 0.03) but not on post-operative day 1 and 2. Local anaesthetic infusion was associated with a significant reduction in pain VAS on movement on all three post-operative days (day 1 weighted mean difference: -1.14; 95% CI: -2.24 to -0.041; P = 0.04, day 2 weighted mean difference: -0.97, 95% CI: -1.91 to -0.029; P = 0.04, day 3 weighted mean difference: -0.61; 95% CI: 1.01 to -0.20; P = 0.0038). Local anaesthetic wound infusion was associated with a significant decrease in total opioid consumption (weighted mean difference: -40.13; 95% CI: -76.74 to -3.53; P = 0.03). There was no significant decrease in length of stay (weighted mean difference: -20.87; 95% CI: -46.96 to 5.21; P = 0.12) or return of bowel function (weighted mean difference: -9.40; 95% CI: -33.98 to 15.17; P = 0.45).

CONCLUSION: The results of this systematic review and meta-analysis suggest that local anaesthetic wound infusion following laparotomy for major colorectal surgery is a promising technique but do not provide conclusive evidence of benefit. Further research is required including cost-effectiveness analysis.

Keywords: Colorectal surgery; Laparotomy; Local anaesthesia; Infusion; Wound healing