Local anaesthetic wound infusion for postoperative pain management following an abdominal hysterectomy: A systematic review and meta-analysis

Abstract

Background: An abdominal hysterectomy is one of the most commonly performed major surgical procedures worldwide, used to surgically manage a broad range of gynaecological conditions. It is associated with moderate to severe postoperative pain. Infusion of a local anaesthetic into tissues surrounding the surgical incision, via a multi-lumen indwelling wound catheter may reduce postoperative pain, opioid consumption, opioid related adverse events and the length of hospital stay. Objectives: To evaluate the efficacy of local anaesthetic wound infusion for postoperative pain management following an abdominal hysterectomy, by assessing pain scores and opioid consumption as the primary objectives. Methods: We searched the PubMed, Web of Science, MEDLINE Complete, SCOPUS, Cochrane Library and OVID databases from inception until April 2023 to identify trials relevant to this review. We augmented the search by searching reference lists of relevant studies to identify other potential eligible studies. Relevant studies were included based on predetermined inclusion and exclusion criteria. A random effects model of meta-analysis was performed. Results: This review included six randomised controlled trials that enrolled a total of 244 patients undergoing abdominal hysterectomy comparing infusion of a local anaesthetic to a placebo or sham. In general, studies had no clear risks of bias concerns, except for one study. Wound infusion of local anaesthetic produced a significant reduction in pain at rest [-6.46 (- 11.22; -1.70)] and opioid consumption [-21.30 (-34.78; -7.83)] 24 hours post abdominal hysterectomy. The analysis reported no complications associated with the intervention of local anaesthetic infusion. There was no significant reduction in pain on movement 24 hours post- surgery. The included trials varied according to dose, type of local anaesthetic and location of wound catheter. There was significant heterogeneity in the analysis undertaken. Conclusion: Local anaesthetic infusion post abdominal hysterectomy is a safe and effective way of reducing pain at rest and opioid consumption 24 hours post-surgery. Further research is warranted to assess the true effectiveness of this technique for pain management.