Updates on Wound Infiltration Use for Postoperative Pain Management: A Narrative Review

Abstract

Local anesthetic wound infiltration (WI) provides anesthesia for minor surgical procedures and improves postoperative analgesia as part of multimodal analgesia after general or regional anesthesia. Although pre-incisional block is preferable, in practice WI is usually done at the end of surgery. WI performed as a continuous modality reduces analgesics, prolongs the duration of analgesia, and enhances the patient's mobilization in some cases. WI benefits are documented in open abdominal surgeries (Caesarean section, colorectal surgery, abdominal hysterectomy, herniorrhaphy), laparoscopic cholecystectomy, oncological breast surgeries, laminectomy, hallux valgus surgery, and radical prostatectomy. Surgical site infiltration requires knowledge of anatomy and the pain origin for a procedure, systematic extensive infiltration of local anesthetic in various tissue planes under direct visualization before wound closure or subcutaneously along the incision. Because the incidence of local anesthetic systemic toxicity is 11% after subcutaneous WI, appropriate local anesthetic dosing is crucial. The risk of wound infection is related to the infection incidence after each particular surgery. For WI to fully meet patient and physician expectations, mastery of the technique, patient education, appropriate local anesthetic dosing and management of the surgical wound with "aseptic, non-touch" technique are needed.

Keywords: anesthetics; catheters; dosage; indwelling; local/administration; pain; postoperative therapy.

Figure 1

Summary of wound infiltration (WI) application in the preoperative and intraoperative period. European Society of Regional Anesthesia procedure-specific postoperative pain management (PROSPECT) working group recommended WI as part of multimodal pain management for several types of surgical procedures. Published studies suggest that WI is appropriate and safe when other techniques are contraindicated, but requires further investigation for efficiency in different kind of surgeries. WI-wound infiltration; CWI-continuous wound infiltration.

Figure 2

Needle insertion at a 90-degree angle during skin penetration passes through fewer pain fibers and reduces injection pain.

Figure 3

Check-list for single-shot wound infiltration planning, performance, and follow-up.