What is the role of local anesthesia in managing pain after surgical incisions?

From the Guidelines

Local anesthesia should be applied to surgical incisions after surgery to manage pain, as it has been shown to reduce pain scores, opioid consumption, and length of hospital stay, with minimal systemic effects and rare side effects, as demonstrated in a systematic review and meta-analysis published in 2021 1. The most effective local anesthetics for this purpose are lidocaine (1-2%), bupivacaine (0.25-0.5%), and ropivacaine (0.2-0.5%), which can be administered as a one-time infiltration around the incision site at the end of surgery or through continuous infusion via wound catheters for 2-3 days postoperatively. Some key points to consider when administering local anesthesia include:

• Using proper sterile technique to minimize the risk of infection
• Avoiding exceeding maximum safe doses (lidocaine 4.5 mg/kg, bupivacaine 2 mg/kg) to prevent systemic toxicity
• Monitoring patients for rare allergic reactions or local infection at the injection site
• Considering the use of multimodal analgesia approaches, including nonsteroidal anti-inflammatory drugs (NSAIDs) and regional anaesthetic techniques, to reduce opioid requirements and improve postoperative recovery, as recommended in the 2021 update of the guidelines for perioperative care in bariatric surgery 1. The anesthetic effect of local anesthesia typically lasts 2-8 hours for single infiltration, with bupivacaine and ropivacaine providing longer duration than lidocaine, and can be repeated as needed to maintain adequate pain control. Overall, the use of local anesthesia in surgical incisions after surgery is a safe and effective way to manage pain, reduce opioid consumption, and improve postoperative recovery, and should be considered as part of a multimodal analgesia approach, as supported by the evidence from studies published in 2020 1 and 2021 1.

From the Research

Local Anesthesia for Incisions After Surgery

• Local anesthesia is commonly used to manage postoperative pain after surgery 2, 3, 4
• The choice of local anesthetic agent can affect the duration and efficacy of pain relief 2, 5, 6
• Bupivacaine and lidocaine are two commonly used local anesthetic agents, with bupivacaine having a longer duration of action 2, 6
• Studies have compared the efficacy of bupivacaine and lidocaine in reducing postoperative pain, with some showing that bupivacaine provides longer lasting pain relief 2, 6
• The use of liposomal bupivacaine, a long-acting formulation of bupivacaine, has also been studied, with some evidence suggesting it may provide longer analgesia than conventional local anesthetics 5

Comparison of Bupivacaine and Lidocaine

• A study comparing bupivacaine and lidocaine for postoperative pain management after single-port access laparoscopic adnexal surgery found that bupivacaine provided significantly lower pain scores at 24 and 48 hours post-operation 2
• Another study comparing bupivacaine and lidocaine for impacted third molar surgery found that bupivacaine had a longer duration of action, but similar postoperative analgesic efficacy to lidocaine 6
• A systematic review of liposomal bupivacaine and conventional local anesthetic agents found that there is limited evidence to suggest that liposomal bupivacaine provides longer analgesia than conventional local anesthetics 5

Postoperative Pain Management

• Effective postoperative pain management is crucial for patient care and outcomes 3, 4
• A multimodal approach to pain management, including the use of local anesthetics, is recommended 3
• Patient education, preoperative planning, and pain assessment are also important considerations for postoperative pain management 3, 4