Bertoglio, S., Fabiani, F., Negri, P.D., Corcione, A., Merlo, D.F., Cafiero, F., . . . Zappi, L. (2012). The postoperative analgesic efficacy of preperitoneal continuous wound infusion compared to epidural continuous infusion with local anesthetics after colorectal cancer surgery: A randomized controlled multicenter study. Anesthesia and Analgesia, 115, 1442–1450.
To evaluate the effectiveness of preperitoneal continuous wound infusion (CWI) with ropivacaine, compared to continuous epidural infusion (CEI) with ropivacaine, on pain control after open colorectal surgery and on the quality of patient recovery
The intervention group had preperitoneal CWI analgesia. The control group had preperitoneal CEI analgesia. Participants were randomly assigned and received either CWI or CEI during first 48 hours postop. Infusion consisted of 0.2% ropivacaine at 10 ml/hour. All patients received morphine patient-controlled analgesia during the first 72 hours postop. All received standardized postoperative care not adhering to fast-track surgery programs. Investigators used the 100 mm visual analog scale (VAS) to measure pain.
A 4.5-point difference in VAS pain score showed that preperitoneal CWI was not inferior to CEI analgesia.
Multicenter randomized controlled trial (noninferiority design)
The primary outcome measure was a VAS whose scale ranged from 0 (no pain) to 100 (worst pain imaginable).
Other outcome measures included
CWI provides an acceptable alternative to CEI for the management of patients' pain after colorectal surgery for the treatment of cancer.
The study had a risk of bias due to no blinding.
This study shows that oncology nurses, as advocates for patients, can support CWI as an alternative to CEI as a means of postoperative pain management. Because CWI was associated with significant benefits regarding postoperative sleep disturbance, bowel function, and nausea and vomiting—as well as pain management—nurses can advocate for the use of CWI to address several symptoms of concern to oncology patients and direct-care nurses.