title: Postoperative analgesia with continuous wound infusion of local anaesthesia vs saline: a double-blind randomized, controlled trial in colorectal surgery.
abstract: OBJECTIVE
  The aim of this prospective double-blind randomized clinical trial was to determine whether preperitoneal continuous wound infusion (CWI) of the local anaesthetic ropivacaine after either laparotomy or video-assisted laparoscopy for colorectal surgery would reduce patient consumption of morphine.
  
  
  METHODS
  Patients scheduled for colorectal surgery randomly received a 48-h preperitoneal CWI of either 0.38% ropivacaine or 0.9% saline at rates of 5 ml/h after laparotomy or 2 ml/h after laparoscopy. The primary end-point was total morphine consumption in surgery and afterwards through a patient-controlled analgesia device. Results in the laparotomy and laparoscopy subgroups were also compared.
  
  
  RESULTS
  Sixty-seven patients were included, 33 in the ropivacaine CWI group and 34 in the saline group. Median [interquartile range (IQR)] morphine consumption was lower in the ropivacaine group [23.5 mg (11.25-42.75)] than in the saline group [52 mg (24.5-64)] (P = 0.010). Morphine consumption was also lower in the laparotomy subgroup receiving ropivacaine [21.5 (15.6-34.7)] than in the saline group [52.5 (22.5-65) ml] (P = 0.041). Consumption was statistically similar in laparoscopy patients on ropivacaine or saline. No side effects were observed. Sixteen patients had a surgical wound infection (23.9%); 11 (16.4%) presented wound infection and five (7.5%) organ space infection. Forty-six catheter cultures were obtained; 10 (21.7%) were positive, assessed to be due to contamination.
  
  
  CONCLUSIONS
  Preperitoneal CWI of ropivacaine is a good, safe addition to a multimodal analgesia regimen for colorectal surgery. CWI can reduce morphine consumption without increasing adverse effects.
authors.affiliation: Department of Anaesthesia, Reanimation and Pain Clinic, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Fustran
authors.forename: A
authors.initials: A
authors.lastname: Dalmau
authors.forename: E
authors.initials: E
authors.lastname: Ferreres
authors.forename: I
authors.initials: I
authors.lastname: Camprubí
authors.forename: R
authors.initials: R
authors.lastname: Sanzol
authors.forename: S
authors.initials: S
authors.lastname: Redondo
authors.forename: E
authors.initials: E
authors.lastname: Kreisler
authors.forename: S
authors.initials: S
authors.lastname: Biondo
authors.forename: A
authors.initials: A
authors.lastname: Sabaté
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000627:therapeutic use*; D003082:Colectomy; D013505:Digestive System Surgical Procedures; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D036502:Infusions, Intralesional; D010535:Laparoscopy; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy*; D011182:Postoperative Care / Q000379:methods; D012007:Rectum / Q000601:surgery*; D000077212:Ropivacaine; D012965:Sodium Chloride; D013530:Surgical Wound Infection; D055815:Young Adult
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D012965:Sodium Chloride; D009020:Morphine; D000077212:Ropivacaine
keywords: Wound analgesia; laparoscopy; laparotomy; local anaesthesia; pain