Surgical Site Infiltration: A Neuroanatomical Approach

Publication date: Available online 25 July 2019Source: Best Practice & Research Clinical AnaesthesiologyAuthor(s): Girish P. Joshi, Anthony MachiAbsractLocal anaesthetic administration into a surgical wound blocks the noxious stimuli that result from surgical insult at the site of origin. Surgical site infiltration (also known as local infiltration analgesia) is easy to perform, safe, and inexpensive. In addition, it avoids motor blockade, which is particularly relevant for lower limb surgery. The best approach to surgical site infiltration includes meticulous, systematic and extensive surgical site local anaesthetic infiltration in the various tissue planes under direct visualization prior to closure of the surgical wound. Local anaesthetic solutions that could be used include bupivacaine HCl, ropivacaine, or liposomal bupivacaine diluted with preservative-free normal (0.9%) saline to a total volume depending upon the size of the incision. Bupivacaine and ropivacaine are sometimes combined with additives which have controversial benefits. Continuous wound infusion with preperitoneal wound catheters is an effective pain modality in abdominal surgery and can be used as an alternative for neuraxial analgesia. It is essential that surgical site infiltration is combined with other non-opioid analgesics such as paracetamol and non-steroidal anti-inflammatory drugs to attain the maximum analgesic efficacy.
Source: Best Practice and Research Clinical Anaesthesiology - Category: Anesthesiology Source Type: research