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Background Transversus abdominis plane (TAP) block and local anaesthetic wound infiltration are used to relieve pain after caesarean section. Objectives To determine whether TAP block or local anaesthetic wound infiltration is the better analgesic option after caesarean section. Design Systematic review and meta-analysis with trial sequential analysis. Data sources MEDLINE, Embase, Cochrane Central Register of Controlled Clinical Trials, Web of Science up to June 2020. Eligibility criteria We retrieved randomised controlled trials comparing TAP block with wound infiltration after caesarean section. Primary outcome was pain score during rest (analogue scale, 0 to 10) at 2 h postoperatively, analysed according to the TAP block technique (ultrasound-guided/landmark-guided), anaesthetic strategy (spinal/general), intrathecal fentanyl (yes/no) and multimodal analgesia (yes/no). Secondary pain-related outcomes included pain scores during rest at 12 and 24 h, and total intravenous morphine consumption at 2, 12 and 24 h. We sought rates of block complications, including postoperative infection, haematoma, visceral injury and local anaesthetic systemic toxicity. Results Seven trials, totalling 475 patients, were identified. There was no difference in pain score during rest at 2 h between groups. Subgroup analyses revealed no differences related to TAP block technique (P = 0.64), anaesthetic strategy (P = 0.53), administration of intrathecal fentanyl (P = 0.59) or presence of multimodal analgesia (P = 0.57). Pain score during rest at 12 h and intravenous morphine consumption at 2 and 12 h were identical in both groups. Data were insufficient to compare block complications. Overall quality of evidence was moderate. Conclusion There is moderate level evidence that TAP block and wound infiltration provide similar postoperative analgesia after caesarean section. Trial registry number PROSPERO CRD42020208046.

This study was aimed to assess the outcome of Ilioinguinal, Iliohypogastric block and wound infiltration with 0.75% ropivacaine on pain perception, first analgesic request and hospital stay following inguinal Lichtenstein mesh repair.This was a prospective, randomized, double-blind study with 60 patients undergoing inguinal hernioplasty under general anesthesia. Patients were randomly allocated to one of the two groups by the sealed envelope method. Group 1 (n=30) received nerve blocks and incision infiltration with 0.75% ropivacaine while group 2 (n=30) received isotonic saline. Postoperatively pain intensity, time of demand for the first analgesic and duration of hospital stay were assessed.Median Visual Analog Scale (VAS) score of group 1 was 4 (high=6, low=3) while for group 2 was 5.50 (high=8, low=4) and the p value was0.001. Mean time for the demand of the first analgesic was prolonged from 1.19±1.05 h to 5.31±1.14 h with the p value of0.0005, while the mean time of hospital stay was reduced from 22.5±3.30 h to 14.1±2.99 h with the p value of0.0005.Preemptive analgesia with 0.75% ropivacaine causes significant reduction in pain perception, request for an analgesic and hospital stay. Therefore it is advisable before inguinal hernioplasty.

CONTEXTThe transversus abdominis plane (TAP) block is a new regional anaesthesia technique applicable to infants and children.OBJECTIVE(S)The present study was designed to evaluate the analgesic efficacy of ultrasound-guided TAP block with high volume local anaesthetic (0.5 ml kg−1) during the first

To examine the available and emerging evidence of the use of topically applied analgesics with particular reference to day case anaesthesia.Current postoperative pain therapy revolves around the use of wound infiltration and systemic administration of opioids, nonsteroidal anti-inflammatory drugs and paracetamol. However, since the origin of postoperative pain is the surgically inflicted wound, there is appeal to localized application of drug to the site of injury, with the hope of enhanced pain relief and a reduction in the side effects associated with systemic administration of drugs. With our enhanced knowledge of the origin and modulation of postoperative pain, it is clear that there are a variety of peripheral targets for our pharmacological interventions. In this review these targets are discussed along with suggestion of which available and emerging drugs are and may be available to interact with these pharmacological targets.A variety of targets for peripherally applied analgesics exists, some of which can be accessed using currently available drugs, whereas others may need development of new formulations before they can be clinically targeted.

Purpose of review Wound infiltration analgesia using local anaesthetics has been used for several decades. Recently, newer techniques to prolong analgesia have developed, including the use of catheters and injection of local anaesthetics or other adjuvants, and local infiltration analgesia using large volumes of local anaesthetics injected into different tissue planes. The aim of this review is to present the current status of wound infiltration analgesia in management of postoperative pain and to highlight the risks of this technique in clinical practice. Recent findings Several studies have shown beneficial effects of local anaesthetics, with or without adjuvant drugs, in the management of postoperative pain. Specifically, the use of local anaesthetics injected via catheters to prolong analgesia reduces postoperative pain, albeit to a limited extent. The use of large volumes of local anaesthetics into tissue planes during surgery is also beneficial in pain management. Single doses of local anaesthetics provide pain relief, but the short duration of effect can be a limiting factor. There is a growing concern about some side-effects associated with the use of local anaesthetics, specifically toxicity when drugs are injected in large doses, chondrotoxicity when bupivacaine is injected intra-articularly in higher concentrations and over a period and finally, infection when using catheters that are retained in situ. Summary Used correctly and in adequate doses, wound infiltration analgesia can be used in a multimodal analgesic regime without major complications. It offers the benefit of providing analgesia at a low cost when used as a single injection.

Objectives This randomized double-blind study was designed to compare the postoperative analgesic effect of clonidine administered intravenously or in wound infiltration with bupivacaine. Methods Sixty adults of ASA grade I–II undergoing open cholecystectomy were randomly allocated into three groups. Group 1 (control group) patients received wound infiltration with 30 ml of 0.25% bupivacaine at the end of surgery. Group 2 patients received 3 μg kg−1 clonidine intravenously after resection of gall bladder plus wound infiltration with 30 ml of 0.25% bupivacaine. Group 3 patients received wound infiltration with 3 μg kg−1 clonidine with 30 ml of 0.25% bupivacaine. A standard general anaesthesia technique was used. Postoperative analgesia was provided with i.v. diclofenac and morphine on demand. Postoperative pain, number of patients requiring rescue analgesia and total morphine consumption during 24 h after operation was recorded. Results Postoperative morphine consumption was significantly less in patients receiving clonidine by either route when compared with the control group (P Conclusions Clonidine 3 μg kg−1 provided effective postoperative analgesia and reduced morphine requirement when administered intravenously or in wound infiltration with bupivacaine. However, the incidence of complications was less with wound infiltration. Clinical trial registry of India (www.ctri.nic.in/), registration number CTRI/2012/12/003258.

We conducted a randomized, double-blind trial to compare the efficacy of preincisional and postincisional wound infiltration with 1% lidocaine (40 mL) on the postoperative pain of 37 patients scheduled for elective inguinal herniotomy. The demand for additional postoperative analgesics occurred earlier in those who received lidocaine infiltration after incision (165 min) than in those who received preincisional lidocaine (225 min, P less than 0.05). The preincisional lidocaine infiltration group also had fewer patients requiring supplemental analgesics (58%) than the postincisional group (94%) (P less than 0.05). We conclude that preincisional infiltration of the surgical wound with lidocaine is a more effective method of providing postoperative analgesia than is postincisional infiltration.