Best Infiltration Practices App

Local Analgesic Infiltration Techniques for Abdominal Surgery

Best Infiltration Practices - local analgesic techniques for abdominal and orthopedic surgery

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Key Points Introduction ÎMore than 90 million surgical procedures are conducted annually in the United States. Many can benefit from local analgesic wound infiltration.1 ÎDespite recent advances, 86% of patients report moderate to extreme pain following surgery.2 ÎPain is the most common cause of hospital readmissions after ambulatory surgery.3 ÎMultimodal strategies using two or more analgesic agents and including administration of local analgesics are recommended by major postsurgical pain guidelines — e.g., American Pain Society (APS), American Society of Anesthesiologists (ASA), American Society of PeriAnesthesia Nurses (ASPAN), Department of Defense (DOD).4-10 ÎSince their clinical use was first demonstrated more than 120 years ago, local analgesics have provided an alternative to general anesthesia and an adjunct to better managing postsurgical pain that has proved beneficial for both patients and practitioners.11-17 ÎManaging postsurgical pain with minimal use of opioids has been shown to accelerate patient recovery; reduce complications, hospital stays and readmissions; and improve overall patient outcomes.11-17 ÎWound infiltration with local analgesics has demonstrated benefits for reducing postsurgical pain and the use of opioids, minimizing their expensive complications that cause patient harm and thereby shortening hospital stays and reducing readmissions.11-16,18 ÎThe recent addition of a 72-hour liposome formulation of bupivacaine substantially and favorably alters the paradigm for evaluating and using surgical wound infiltration to improve pain scores, significantly reduce the need for opioids and improve patient satisfaction.11,19 ÎAlways consider maximum dose and patient weight when infiltrating. Because amide-type local anesthetics such as bupivacaine are metabolized by the liver, they should be used cautiously in patients with hepatic disease. Patients with severe hepatic disease are at a greater risk of developing toxic plasma concentrations.12 ÎImproving local analgesic administration techniques can facilitate ease of use and benefit patients. This is the goal of the Best Infiltration Practices Working Group and its expert recommendations.

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