Pain management

Postoperative pain remains prevalent and is the greatest concern for a patient.

The intense pain in the postoperative period may have a major impact on patients. Inadequate pain management causes suffering and distress, and might lead to some postoperative complications, prolong hospitalization, and trigger chronic pain syndromes.

Over the past decade there has been an increasing reliance on strong opioids for effective pain relief, which has been associated with a rising epidemic of prescription opioid misuse, abuse, and overdose-related deaths. Deaths from prescription opioids have more than quadrupled in the USA since 19991), and this pattern is now occurring globally. In 2020, an average of 44 people died each day in the USA from overdoses involving prescription opioids, totaling more than 16,000 deaths1). Inappropriate opioid prescribing after surgery, particularly after discharge, is a major cause of this problem.

Many studies focused on reducing opioid consumption hence demand for regional pain management via wound infiltration have increased significantly. Studies have found wound infiltration to be effective in reducing opioid demand and improving pain scores.

Continuous wound infiltration (CWI) is an analgesic technique to administer local anesthetics directly into the surgical wound at a constant speed, through a multi-holed catheter that is placed by the surgeon at the end of the surgery.

CWI is an effective, well proven, and safe analgesic technique that is simple to perform compared to other analgesic techniques such as peripheral nerve blocks or epidural analgesia.

The benefits of this technique over conventional analgesia2

The CWI can be used for several days and, thanks to the development of new pumps, a variety of continuous delivery methods can be chosen, including patient-controlled analgesia, continuous infusion, or intermittent bolus.

Source: 1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2021. Available at 2. Liu S S, Richman J M, Thirlby R C, Wu C L. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. Journal of the American College of Surgeons 2006; 203(6): 914-932