title: Continuous wound infusion of local anaesthetic agents following colorectal surgery: systematic review and meta-analysis.
abstract: OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB22QQ, United Kingdom.
authors.forename: Alan
authors.initials: A
authors.lastname: Karthikesalingam
authors.forename: Stewart R
authors.initials: SR
authors.lastname: Walsh
authors.forename: Sheraz R
authors.initials: SR
authors.lastname: Markar
authors.forename: Umar
authors.initials: U
authors.lastname: Sadat
authors.forename: Tjun Y
authors.initials: TY
authors.lastname: Tang
authors.forename: Charles M
authors.initials: CM
authors.lastname: Malata
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000191:economics; D003362:Cost-Benefit Analysis; D013505:Digestive System Surgical Procedures; D006801:Humans; D036502:Infusions, Intralesional; D010149:Postoperative Pain / Q000188:drug therapy / Q000503:physiopathology
chemical_list: D000779:Anesthetics, Local
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