title: Surgically placed wound catheters (SPWC) and local anaesthetic infusion in breast surgery: efficacy and safety analysis.
abstract: BACKGROUND
  The effectiveness of surgically placed wound catheters (SPWC) and local anaesthetic infusion in the management of post-operative pain following breast surgery is controversial. This meta-analysis was performed to assess efficacy SPWC compared to other techniques of pain management.
  
  
  METHODS
  The meta-analysis included randomised control trials that compared SPWC with other forms of pain control. Post-operative opioid requirements and pain measured in visual analogue scale (VAS) were analysed using Comprehensive Meta-analysis Software version 2. Literature was reviewed for the safety of the SPWC and local anaesthetic infusion.
  
  
  RESULTS
  Four randomised controlled trials evaluating 147 women were included in the final analysis. The overall standard difference in means was 0.094 and 0.033 for post-operative opioid requirement and pain respectively favouring the SPWC and local anaesthetic infusion group. It is a safe technique with no major adverse events as a result.
  
  
  CONCLUSIONS
  Surgically placed wound catheters and local anaesthetic infusion is clinically safe in a wide range of surgical procedures on the breast and there appears to be a trend towards improved post operative pain relief. The studies analyzed in this review have several important drawbacks such as inadequate power to detect significant differences (none of them included more than 50 patients). A well designed RCT of patients undergoing breast surgery with an adequate number is of patients required to emphatically demonstrate if the operative site infusion with local anaesthetic solution postoperatively is safe and efficacious compared to opioid based regimens alone for post operative pain relief.
authors.affiliation: Wansbeck General Hospital, Ashington, UK. g.raghavendra@NHS.net
authors.forename: G K G
authors.initials: GK
authors.lastname: Raghavendra
authors.forename: R H
authors.initials: RH
authors.lastname: Sreenivasa
authors.forename: K
authors.initials: K
authors.lastname: Ashok
authors.forename: P
authors.initials: P
authors.lastname: Chitsabesan
authors.forename: N R
authors.initials: NR
authors.lastname: McLean
authors.forename: M
authors.initials: M
authors.lastname: Youssef
authors.forename: M
authors.initials: M
authors.lastname: Piper
authors.forename: M
authors.initials: M
authors.lastname: Carr
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D001940:Breast / Q000601:surgery*; D002408:Catheters, Indwelling; D005260:Female; D006801:Humans; D007260:Infusion Pumps; D016462:Mammaplasty / Q000379:methods; D008408:Mastectomy / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local