title: Influence of different positioning of a local pain catheter on postoperative pain after paramedian laparotomy-a blinded, randomized trial.
abstract: BACKGROUND
  Continuous application of local anaesthetics reduces postoperative pain after different approaches for laparotomy. In this randomized, blinded trial, we investigated the effect of continuous application of local anaesthetics after paramedian laparotomy either with subfascial or subcutaneous catheter in addition to a standardized systemic analgesia.
  
  
  METHODS
  Patients with stage III/IV melanoma and indication for radical iliac lymph node dissection (RILND) were randomized to a continuous application of a local anaesthetic through either a subfascial or subcutaneous catheter. Participants and those assessing the outcomes were blinded. The main outcome criterion was the pain level on the first postoperative morning while exercising measured with a visual analogue scale. Minor criteria were the pain measured by the area-under-curve until the third postoperative day, the patient's satisfaction with analgesic treatment, the analgesic requirement, the overall complications and the day of discharge.
  
  
  RESULTS
  Fifty-two patients were evaluated. Pain therapy was sufficient in both groups during the postoperative course while resting and during mobilization. There were no significant differences regarding the main and minor outcome criteria. Doses of additional analgesics did not differ between groups. No adverse events or side effects were observed.
  
  
  CONCLUSIONS
  For patients who undergo paramedian laparotomy, none of the investigated techniques is superior to the other at a median pain level under visual analogue scale (VAS) 30 mm on the first postoperative morning.
  
  
  BACKGROUND
  DRKS00003632 (German Register of Clinical Trials).
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. christian.groeger@charite.de.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. christian.groeger@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Groeger
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany. martin.schomaker@charite.de.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany. martin.schomaker@charite.de.
authors.forename: M
authors.initials: M
authors.lastname: Schomaker
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Raue
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.|Department of General, Visceral, Vascular and Thoracic Surgery, Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Charitéplatz 1, 10117, Berlin, Germany.
authors.forename: O
authors.initials: O
authors.lastname: Haase
mesh_terms: D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002406:Catheterization, Peripheral / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000009:adverse effects*; D008197:Lymph Node Excision / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D059408:Pain Management; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011446:Prospective Studies; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local
keywords: Continuous wound infiltration; Lliac lymphadenectomy; Local pain catheter; Melanoma; Postoperative pain