title: Analgesia with interfascial continuous wound infiltration after laparoscopic colon surgery: A randomized clinical trial.
abstract: OBJECTIVE
  For major laparoscopic surgery, as with open surgery, a multimodal analgesia plan can help to control postoperative pain. Placing a wound catheter intraoperatively following colon surgery could optimize the control of acute pain with less consumption of opioids and few adverse effects.
  
  
  METHODS
  We conducted a prospective, randomized, study of patients scheduled to undergo laparoscopic colon surgery for cancer in Galdakao-Usansolo Hospital from January 2012 to January 2013. Patients were recruited and randomly allocated to wound catheter placement plus standard postoperative analgesia or standard postoperative analgesia alone. A physician from the acute pain management unit monitored all patients for pain at multiple points over the first 48 hours after surgery. The primary outcome variables were verbal numeric pain scale scores and amount of intravenous morphine used via patient controlled infusion.
  
  
  RESULTS
  92 patients were included in the study, 43 had a wound catheter implanted and 49 did not. Statistically significant differences in morphine consumption were observed between groups throughout the course of the treatment period. The mean total morphine consumption at the end of the study was 5.63±5.02mg among wound catheter patients and 21. 86±17.88mg among control patients (P=.0001). Wound catheter patients had lower pain scale scores than control patients throughout the observation period. No adverse effects associated with the wound catheter technique were observed. The wound catheter group showed lower hospital stays with statistically significant difference (P=.02).
  
  
  CONCLUSIONS
  In patients undergoing laparoscopic colon surgery, continuous infusion of local anaesthetics through interfascial wound catheters during the first 48h aftersurgery reduced the level of perceived pain and also reduced parenteral morphine consumption with no associated adverse effects and lower hospital stays.
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España. Electronic address: sorkunde.telletxeabenguria@osakidetza.net.
authors.forename: S
authors.initials: S
authors.lastname: Telletxea
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España.
authors.forename: J
authors.initials: J
authors.lastname: Gonzalez
authors.affiliation: Departamento de Cirugía General, Hospital de Galdakao- Usansolo, Bizkaia, España.
authors.forename: V
authors.initials: V
authors.lastname: Portugal
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España.
authors.forename: R
authors.initials: R
authors.lastname: Alvarez
authors.affiliation: Unidad de investigación, Hospital de Galdakao-Usansolo, Bizkaia, España; Red de Investigación en Servicios Sanitarios y enfermedades Crónicas (REDISSEC) Bizkaia, España.
authors.forename: U
authors.initials: U
authors.lastname: Aguirre
authors.affiliation: Unidad de investigación, Hospital de Galdakao-Usansolo, Bizkaia, España; Red de Investigación en Servicios Sanitarios y enfermedades Crónicas (REDISSEC) Bizkaia, España.
authors.forename: A
authors.initials: A
authors.lastname: Anton
authors.affiliation: Departamento de Anestesiología y Reanimación, Hospital de Galdakao- Usansolo, Bizkaia, España.
authors.forename: A
authors.initials: A
authors.lastname: Arizaga
mesh_terms: D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D003108:Colonic Diseases; D006801:Humans; D009020:Morphine; D059408:Pain Management; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine
keywords: Cateterincisional; Consumo de morfina; ENV; Interfascial location; Localización interfascial; Morphine consumption; NRS; Wound catheter