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Acute Pain | Chronic Pain | General

Wound infiltration with local anaesthetic in postoperative pain

Clinical bottom line:

Postoperative use of local anaesthetic at the wound site does not appear to be useful in relieving postoperative pain. However, the review did not state the number of patients included, and it is therefore difficult to be certain of the strength of review findings.


It is thought that administration of local anaesthetic into the surgical wound may modulate pain via peripheral mechanisms. This method has been widely used in minor surgical procedures, although it has been unclear whether there is any clinically relevant benefit.

Systematic review

Dahl JB, Moiniche S, Kehlet H. Wound infiltration with local anaesthetics for postoperative pain relief. Acta-Anaesthesiol-Scand 1994; 38:7-14.

Inclusion criteria were double-blind, placebo-controlled trials of postoperative use of local anaesthetic at wound site; surgical procedure of moderate to major size. The reviewer also included four non-placebo controlled/blinded trials. Theses are not discussed here.

Findings

Pain intensity

Ten trials examined pain intensity. Four of 10 trials reported a significant reduction in pain intensity, but the reviewer regarded this as clinically significant in only one of 10 trials. (Nine ten of the original trials did not state whether pain was assessed at rest or during ambulation).

Additional analgesic use

Thirteen trials examined use of additional opioids. Six of 13 trials reported a significant reduction in opioid use. However, the reviewer regarded only three of these findings as a clinically significant reduction.

Postoperative morbidity

None of the seven trials investigating this demonstrated a clinically significant finding.

Effect of dose, site and time of injection

Eleven trials used bupivacaine 0.5% or 0.25% for infiltration and/or continuous infusion, and two used lidocaine spray. Data from original trials were too diverse to allow for analysis of doses, site or time of injection.

Adverse effects

No trial reported adverse effects

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