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Background: Transversus abdominis plane (TAP) block and wound infiltration (WI) with local anesthetics are used for postoperative analgesia after cesarean section (CS), reducing the need for administration of opioids. Objective: To compare the analgesic effect of TAP block related to WI. Search strategy: MEDLINE, Scopus, ClinicalTrials.gov, EMBASE, Cochrane Library, and CINAHL were searched from inception until April 2020. Selection criteria: Randomized controlled trials (RCTs) about women who underwent TAP block or WI after CS. Data collection and analysis: Relevant data were extracted and tabulated. Review Manager 5.3 was used for data analysis. Primary outcome was cumulative opioid consumption (COC) 24 and 48 h after CS. Main results: Five RCTs, enrolling 268 women, were included. There were no significant differences between the interventions regarding COC at 24 (mean difference [MD] -1.68, 95% confidence interval [CI] -6.29 to 2.93) and 48 hours (MD 1.28, 95% CI -10.44 to 13.00). Adverse effects (relative risk [RR] 0.93, 95% CI 0.75-1.16), gastrointestinal reactions (RR 1.30, 95% CI 0.46-3.68), or mild-moderate sedation (RR 1.12, 95% CI 0.72-1.74), pain scores, satisfaction of women, and withdrawals were similar between groups. Conclusions: There might be no significant advantages selecting TAP block over WI for post-CS analgesia.

Aim To examine whether tramadol wound infiltration decreased postoperative pain following cesarean section (CS) under general anesthesia or reduced the need for analgesics in the immediate postoperative period. Methods In this double-blind, randomized trial, 60 women who underwent elective CS under general anesthesia were randomly allocated to one of two groups: placebo group (group P; n = 30) or tramadol group (group T; n = 30). Group P received 20 mL local wound infiltration with 0.9% saline solution, and group T received 20 mL local wound infiltration with tramadol 2 mg/mL within a 0.9% saline solution. The primary outcome, cumulative morphine consumption, and secondary outcomes including diclofenac requirement and postoperative pain were recorded. Results Numerical rating scale score was lower in group T than in group P at 15 min postoperatively (P < 0.001). Patients in group T required significantly less morphine at all time intervals than those in group P (P < 0.001). There was no difference between groups in need for rescue analgesic dose (P ˃ 0.05). Conclusion Wound infiltration with tramadol may be a useful technique in patients undergoing CS under general anesthesia to reduce postoperative pain and improve recovery.

Wound infiltration with local anaesthetics is a simple, effective and inexpensive means of providing good analgesia for a variety of surgical procedures without any major side-effects. In particular, local anaesthetic toxicity, wound infection and healing do not appear to be major considerations. The purpose of this review is to outline the existing literature on a procedure-specific basis and to encourage a more widespread acceptance of the technique, ensuring that all layers are infiltrated in a controlled and meticulous manner.

Fifty children who underwent day case herniotomy received either a caudal injection of 1 ml/kg bupivacaine 0.25% or infiltration of the wound edges at the end of surgery with 0.5 ml/kg bupivacaine 0.25%, allocated at random. Postoperative pain and demeanour were assessed initially by an observer and later by use of a parental questionnaire. Wound infiltration of local anaesthetic solution provided analgesia which was comparable to that associated with caudal block, and the incidence of side effects was similar in the two groups. Wound infiltration of local anaesthetic offers a simple, safe alternative to caudal block for provision of postoperative analgesia in this group of patients.

The instillation of local anaesthetic agents into surgical wounds has been reported to be an effective method of reducing pain and narcotic requirements, using both local injection1,2 and topical application3 techniques. We performed a double-blind trial to test the value of the long-acting local anaesthetic, bupivacaine, in this role. Eighty patients undergoing elective cholecystectomy were entered into the study. They were divided into 2 groups of 40 patients to compare a local injection technique with a topical application technique. For each route of application. 20 patients received a test solution containing 0.25% plain bupivacaine, and 20 received 0.9% NaCl as a control. Postoperative analgesia in the form of intramuscular pethidine (1–1.5mg/kg) was made available to all patients on request. The degree of postoperative pain was assessed using three criteria: the time from operation to the first request for analgesia, the total dose of postoperative pethidine required during the first 3 postoperative days and the patient's rating of pain on a 10cm linear analogue scale at 24h and 72 h. There was no statistically significant difference between the degree of postoperative pain experienced by patients receiving bupivacaine and those receiving NaCl, when assessed by any criterion. There was also no significant difference found between patients receiving bupivacaine by local infiltration and those receiving the drug topically. It is concluded that the local application of bupivacaine to the wound is not an effective analgesic technique following laparotomy for cholecystectomy.

Introduction: The laparoscopic approach may be associated with more postoperative pain initially. The aim of this study was to evaluate the effects of administered tramadol at wound closure on postoperative pain and analgesic requirements under spinal anesthesia in laparoscopic inguinal herniorrhaphy (LH) or tension free open inguinal herniorrhaphy (TFOH). Methods: Twenty patients were randomly divided into two groups (n= 10 in each) as LH or TFOH. Patients received infi ltration of 200 mg tramadol with 40 mL of 0.9% saline solution at wound closure procedure. Postoperative pain was assessed with a Visual Analog Scale (VAS) at 3, 6, 12, and 24 hours postoperatively. Additional requirements of tramadol for postoperative pain releif were registered. Results: VAS scores at postoperative 12 and 24 hours were signifi cantly higher according to 3rd hour VAS scores in both groups. The VAS scores at 12 hours after operation signifi cantly lower in LH group than in TFOH group (1.5 ± 0.97 vs 5.1 ± 0.99). Additional requirements of tramadol for postoperative pain releif were signifi cantly lower in LH group. Conclusion: We conclude that wound infi ltration of 200 mg tramadol reduce postoperative pain in LH group. © 2012 All rights reserved

E-mail address: bami@medinet.co.za. Multimodal treatment for pain following cesarean delivery can include wound infiltration and peritoneal spraying with ropivacaine hydrochloride [1]. Compared with wound infiltration, peritoneal spraying may allow for greater absorption and serum concentration of the anesthetic agent. The present study was conducted with 10 women who underwent a cesarean delivery at Nelspruit Mediclinic Hospital, South Africa, in 2006. Its objective was to determine serum ropivacaine concentration following administration, by spraying and injection, of 225 mg of the agent to all layers of the anterior abdominal wall and the peritoneum. The study was approved by the Ethics in Human Research Committee of the University of the Witwatersrand. The procedure for wound infiltration and peritoneal spraying has been previously described [1]. Following delivery of the neonate and placenta and closure of the uterine incision,10mL of 0.75% ropivacaine was sprayed onto the edges of the peritoneal wound, 10 mL was Table 1 Mean serum concentration of ropivacaine at different time intervals in 10 patients who underwent local anesthesia following cesarean delivery

Summary Forty-nine boys scheduled for day-case inguinal herniotomy Here studied to compare ilio-inguinal nerve block and wound infiltration for postoperative analgesia. Both techniques were simple to perform and produced no complications. In the ilio-inguinal block group, 100% had either no pain or very mild discomfort when assessed 60 minutes after return to the day unit, compared to 95% in the infiltration group. Some children did appear to have pain following discharge but in all cases this responded well to simple analgesics. We conclude that both techniques provide satisfactory analgesia whilst the complications of narcotics are avoided, and suggest that simple infiltration of the wound with local anaesthetic solution should be encouraged in paediatric anaesthesia.