A combination of continuous wound infiltration system and intravenous patient-controlled analgesia as an effective approach in the management of postoperative pain in gynecologic oncology patients

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A combination of continuous wound infiltration system and intravenous patient-controlled analgesia as an effective approach in the management of postoperative pain in gynecologic oncology patients

A recent finding suggests that combination of continuous wound infiltration system and intravenous patient-controlled analgesia (IV PCA) therapy could be a useful strategy for the management of severe postoperative surgical site pain (POSP) in gynecologic oncology patients.

Major open surgery for gynecologic cancer involves a long midline skin incision and induces severe POSP, and this may not be effectively controlled with the conventional management. A study was conducted on gynecologic oncology patients who underwent surgery to assess the efficacy of the combination of CWIS and IV PCA can decrease POSP as compared to IV PCA therapy alone.

This was a retrospective study which including 62 Korean patients who received a long midline skin incision during their gynecologic cancer surgery. Two groups were formed which were determined using 1:1 matching. One of the group (n=31) received combined therapy (CWIS (0.5% ropivacaine infused over 72 h) and IV PCA (fentanyl citrate)). Another group (n=31) received only IV PCA. For assessment of POSP, resting numeric rating scale (NRS) score was used that measured for 96 h after surgery, and a linear mixed model was used for analysis.

The results revealed that the slopes of the predicted NRS values from the linear mixed model were significantly different among the groups. The combined therapy group showed lower predicted NRS scores for the first 72 h, but higher predicted scores between 72 and 96 h when compared to the control group. For a period of first 48 h post-operation, the mean NRS scores were remarkably lower in the combined therapy group than control group. For remaining period, the scores were found to be similar in both the groups. No difference was reported among groups in variables such as the dosage and usage time of fentanyl citrate, use of additional painkillers and side effects, including wound complications, except a higher body mass index in the CWIS group.

Overall, the study concluded that combination of CWIS and IV PCA therapy could be a useful strategy for the management of POSP in gynecologic oncology patients.

Source:

Arch Gynecol Obstet. 2017 Mar 14

Link to the source:

https://www.ncbi.nlm.nih.gov/pubmed/28293723

The original title of the article:

Continuous wound infiltration system for postoperative pain management in gynecologic oncology patients.

Authors:

Lee B, Kim K, et al.

SearchTags: 
Continuous wound infiltration system, Intravenous patient-controlled analgesia, Postoperative pain, Gynecologic oncology
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