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Continuous wound infiltration (CWI) refers to the continuous infiltration of a local anesthetic into a surgical wound to aid in pain management during post-operative recovery.
| | This article needs additional citations for verification .(March 2019) |
Continuous wound infiltration (CWI) refers to the continuous infiltration of a local anesthetic into a surgical wound to aid in pain management during post-operative recovery.
Continuous wound infiltration first appeared on the market in the late 1990s when a US company (I-Flow Corporation) found a way to evenly spread and continuously infiltrate a local anesthetic, via a specially designed multi holed catheter, inside the wound, to enable post-operative pain treatment.
The benefits of wound infiltration are quite prominent which is the reason why "single shot" wound infiltration had already been done for several decades. The limiting factor of the single shot approach has always been the half-life period of the local anesthetics which would not allow a long term post-op pain treatment.[ citation needed ]
A local anesthetic is administered into the wound with a specially designed, multi-holed catheter. The catheter allows for even spread throughout the entire area of the wound, depending on the size of the catheter.
The surgeon places the catheter during surgery shortly before closing the surgical incision. For best catheter placement and nerve blockage, the catheter must be located as close as possible to the nerve. Tunneling should be applied if a distal infiltration of the adjacent nerve root is preferred.[ citation needed ]
For thoracic and abdominal surgeries, the surgeon will place the catheter superior to the respective fascias. For thoracic surgeries, the catheter goes superior to the pleura. For all type of abdominal surgeries the catheter should be close to the peritoneum. A recent systematic review showed that deep wound catheters (placed pre-peritoneally or in the transversus abdominis plane), provide better pain control than subcutaneous wound catheters after abdominal surgery. [1]
After being placed, the catheter is connected to an elastomeric pump that ensures a constant delivery of the anesthetic and also serves as the drug container. Depending on the flow rate and the pump size, one pump can provide continuous wound infiltration for several days.
CWI is considered as an effective alternative to other regional anesthetic techniques such as peripheral nerve blocks and spinal-epidural anesthesia. It is especially applicable where those techniques are contra-indicated, such as in patients using potent coagulants.
Besides, some patients might prefer an alternative to epidural analgesia because of epidural-related side effects. Epidural analgesia may lead to serious neurological complications (epidural haematoma and abscess, with an incidence of one in 1000–6000 for thoracic epidurals [2] [3] [4] ) and need for preoperative placement in awake patients, considered as cumbersome by many patients, sometimes leading to refusal. [5] [6] [7]
The outcome in most cases is beneficial for the patient because of a faster return to normal body functions, less pain, faster rehabilitation and less side effects. CWI offers the opportunity to significantly minimize the use of narcotics during post-op pain management and reduces the side-effects (post-operative nausea and vomiting) that come with opioids. Also, CWI has been shown to provide more excellent satisfaction scores compared to alternatives. [8]
Anesthesia is a state of controlled, temporary loss of sensation or awareness that is induced for medical purposes. It may include some or all of analgesia, paralysis, amnesia, and unconsciousness. A person under the effects of anesthetic drugs is referred to as being anesthetized.
Local anesthesia is any technique to induce the absence of sensation in a specific part of the body, generally for the aim of inducing local analgesia, that is, local insensitivity to pain, although other local senses may be affected as well. It allows patients to undergo surgical and dental procedures with reduced pain and distress. In many situations, such as cesarean section, it is safer and therefore superior to general anesthesia.
A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general anesthetic. When it is used on specific nerve pathways, paralysis also can be achieved.
Spinal anaesthesia, also called spinal block, subarachnoid block, intradural block and intrathecal block, is a form of neuraxial regional anaesthesia involving the injection of a local anaesthetic or opioid into the subarachnoid space, generally through a fine needle, usually 9 cm (3.5 in) long. It is a safe and effective form of anesthesia usually performed by anesthesiologists that can be used as an alternative to general anesthesia commonly in surgeries involving the lower extremities and surgeries below the umbilicus. The local anesthetic with or without an opioid injected into the cerebrospinal fluid provides locoregional anaesthesia: true analgesia, motor, sensory and autonomic (sympathic) blockade. Administering analgesics in the cerebrospinal fluid without a local anaesthetic produces locoregional analgesia: markedly reduced pain sensation, some autonomic blockade, but no sensory or motor block. Locoregional analgesia, due to mainly the absence of motor and sympathic block may be preferred over locoregional anaesthesia in some postoperative care settings. The tip of the spinal needle has a point or small bevel. Recently, pencil point needles have been made available.
Awareness under anesthesia, also referred to as intraoperative awareness or accidental awareness during general anesthesia (AAGA), is a rare complication of general anesthesia where patients regain varying levels of consciousness during their surgical procedures. While anesthesia awareness is possible without resulting in any long-term memory, the more clinically significant complication is awareness with explicit recall, where patients can remember the events related to their surgery.
Epidural administration is a method of medication administration in which a medicine is injected into the epidural space around the spinal cord. The epidural route is used by physicians and nurse anesthetists to administer local anesthetic agents, analgesics, diagnostic medicines such as radiocontrast agents, and other medicines such as glucocorticoids. Epidural administration involves the placement of a catheter into the epidural space, which may remain in place for the duration of the treatment. The technique of intentional epidural administration of medication was first described in 1921 by Spanish military surgeon Fidel Pagés. In the United States, over 50% of childbirths involve the use of epidural anesthesia.
A thoracotomy is a surgical procedure to gain access into the pleural space of the chest. It is performed by surgeons to gain access to the thoracic organs, most commonly the heart, the lungs, or the esophagus, or for access to the thoracic aorta or the anterior spine. The purpose of a thoracotomy is the first step used to facilitate thoracic surgeries including lobectomy or pneumonectomy for lung cancer or to gain thoracic access in major trauma.
Bupivacaine, marketed under the brand name Marcaine among others, is a medication used to decrease feeling in a specific area. In nerve blocks, it is injected around a nerve that supplies the area, or into the spinal canal's epidural space. It is available mixed with a small amount of epinephrine to increase the duration of its action. It typically begins working within 15 minutes and lasts for 2 to 8 hours.
Nerve block or regional nerve blockade is any deliberate interruption of signals traveling along a nerve, often for the purpose of pain relief. Local anesthetic nerve block is a short-term block, usually lasting hours or days, involving the injection of an anesthetic, a corticosteroid, and other agents onto or near a nerve. Neurolytic block, the deliberate temporary degeneration of nerve fibers through the application of chemicals, heat, or freezing, produces a block that may persist for weeks, months, or indefinitely. Neurectomy, the cutting through or removal of a nerve or a section of a nerve, usually produces a permanent block. Because neurectomy of a sensory nerve is often followed, months later, by the emergence of new, more intense pain, sensory nerve neurectomy is rarely performed.
The Nuss procedure is a minimally-invasive procedure, invented in 1987 by Dr. Donald Nuss for treating pectus excavatum. He developed it at Children's Hospital of The King's Daughters, in Norfolk, Virginia. The operation typically takes approximately two hours.
A rib fracture is a break in a rib bone. This typically results in chest pain that is worse with inspiration. Bruising may occur at the site of the break. When several ribs are broken in several places a flail chest results. Potential complications include a pneumothorax, pulmonary contusion, and pneumonia.
Chloroprocaine is a local anesthetic given by injection during surgical procedures and labor and delivery. Chloroprocaine vasodilates; this is in contrast to cocaine which vasoconstricts. Chloroprocaine is an ester anesthetic.
A spinal cord stimulator (SCS) or dorsal column stimulator (DCS) is a type of implantable neuromodulation device that is used to send electrical signals to select areas of the spinal cord for the treatment of certain pain conditions. SCS is a consideration for people who have a pain condition that has not responded to more conservative therapy.
Shoulder replacement is a surgical procedure in which all or part of the glenohumeral joint is replaced by a prosthetic implant. Such joint replacement surgery generally is conducted to relieve arthritis pain or fix severe physical joint damage.
Brachial plexus block is a regional anesthesia technique that is sometimes employed as an alternative or as an adjunct to general anesthesia for surgery of the upper extremity. This technique involves the injection of local anesthetic agents in close proximity to the brachial plexus, temporarily blocking the sensation and ability to move the upper extremity. The subject can remain awake during the ensuing surgical procedure, or they can be sedated or even fully anesthetized if necessary.
The history of neuraxial anesthesia goes back to 1885.
Intercostal nerve block is a nerve block which temporarily or permanently interrupts the flow of signals along an intercostal nerve, usually performed to relieve pain.
Local anesthetic nerve block is a short-term nerve block involving the injection of local anesthetic as close to the nerve as possible for pain relief. The local anesthetic bathes the nerve and numbs the area of the body that is supplied by that nerve. The goal of the nerve block is to prevent pain by blocking the transmission of pain signals from the surgical site. The block provides pain relief during and after the surgery. The advantages of nerve blocks over general anesthesia include faster recovery, monitored anesthesia care vs. intubation with an airway tube, and much less postoperative pain.
Gábor Béla Rácz, is a Hungarian-American board-certified anesthesiologist and professor emeritus at Texas Tech University Health Science Center (TTUHSC) in Lubbock, Texas, where he is also Chairman Emeritus of the Department of Anesthesiology and Co-Director of Pain Services. He has worked in the field of chronic back pain and complex regional pain syndrome (CRPS).
Anterior cutaneous nerve entrapment syndrome (ACNES) is a nerve entrapment condition that causes chronic pain of the abdominal wall. It occurs when nerve endings of the lower thoracic intercostal nerves (7–12) are 'entrapped' in abdominal muscles, causing a severe localized nerve (neuropathic) pain that is usually experienced at the front of the abdomen.
