Surgical site infiltration for abdominal surgery: A novel neuroanatomical-based Approach

Girish P Joshi, Jeffrey E. Janis, Eric M. Haas, Bruce J. Ramshaw, Mikio A. Nihira, Brian J. Dunkin

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. Methods: Literature searches were conducted for studies reporting the neuroana-tomical sources of pain after abdominal surgery. Also, studies identified by preceding search were reviewed for relevant publications and manually retrieved. Results: Based on neuroanatomy, an optimal surgical site infiltration technique would consist of systematic, extensive, meticulous administration of local anesthetic into the peritoneum (or preperitoneum), subfascial, and subdermal tissue planes. The volume of local anesthetic would depend on the size of the incision such that 1 to 1.5mL is injected every 1 to 2cm of surgical incision per layer. It is best to infiltrate with a 22-gauge, 1.5-inch needle. The needle is inserted approximately 0.5 to 1cm into the tissue plane, and local anesthetic solution is injected while slowly withdrawing the needle, which should reduce the risk of intravascular injection. Conclusions: Meticulous, systematic, and extensive surgical site local anesthetic infiltration in the various tissue planes including the peritoneal, musculofascial, and subdermal tissues, where pain foci originate, provides excellent postoperative pain relief. This approach should be combined with use of other nonopioid analgesics with opioids reserved for rescue. Further well-designed studies are necessary to assess the analgesic efficacy of the proposed infiltration technique.

Original languageEnglish (US)
Article numbere1181
JournalPlastic and Reconstructive Surgery - Global Open
Volume4
Issue number12
DOIs
StatePublished - Jan 1 2016

Fingerprint

Local Anesthetics
Non-Narcotic Analgesics
Needles
Neuroanatomy
Analgesia
Analgesics
Nociceptive Pain
Postoperative Pain
Abdominal Pain
Opioid Analgesics
Walking
Publications
Rehabilitation
Injections

ASJC Scopus subject areas

  • Surgery

Cite this

Surgical site infiltration for abdominal surgery : A novel neuroanatomical-based Approach. / Joshi, Girish P; Janis, Jeffrey E.; Haas, Eric M.; Ramshaw, Bruce J.; Nihira, Mikio A.; Dunkin, Brian J.

In: Plastic and Reconstructive Surgery - Global Open, Vol. 4, No. 12, e1181, 01.01.2016.

Research output: Contribution to journalArticle

Joshi, Girish P ; Janis, Jeffrey E. ; Haas, Eric M. ; Ramshaw, Bruce J. ; Nihira, Mikio A. ; Dunkin, Brian J. / Surgical site infiltration for abdominal surgery : A novel neuroanatomical-based Approach. In: Plastic and Reconstructive Surgery - Global Open. 2016 ; Vol. 4, No. 12.
@article{3b9e02a22ef34e80bd287a68ace54062,
title = "Surgical site infiltration for abdominal surgery: A novel neuroanatomical-based Approach",
abstract = "Background: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. Methods: Literature searches were conducted for studies reporting the neuroana-tomical sources of pain after abdominal surgery. Also, studies identified by preceding search were reviewed for relevant publications and manually retrieved. Results: Based on neuroanatomy, an optimal surgical site infiltration technique would consist of systematic, extensive, meticulous administration of local anesthetic into the peritoneum (or preperitoneum), subfascial, and subdermal tissue planes. The volume of local anesthetic would depend on the size of the incision such that 1 to 1.5mL is injected every 1 to 2cm of surgical incision per layer. It is best to infiltrate with a 22-gauge, 1.5-inch needle. The needle is inserted approximately 0.5 to 1cm into the tissue plane, and local anesthetic solution is injected while slowly withdrawing the needle, which should reduce the risk of intravascular injection. Conclusions: Meticulous, systematic, and extensive surgical site local anesthetic infiltration in the various tissue planes including the peritoneal, musculofascial, and subdermal tissues, where pain foci originate, provides excellent postoperative pain relief. This approach should be combined with use of other nonopioid analgesics with opioids reserved for rescue. Further well-designed studies are necessary to assess the analgesic efficacy of the proposed infiltration technique.",
author = "Joshi, {Girish P} and Janis, {Jeffrey E.} and Haas, {Eric M.} and Ramshaw, {Bruce J.} and Nihira, {Mikio A.} and Dunkin, {Brian J.}",
year = "2016",
month = "1",
day = "1",
doi = "10.1097/GOX.0000000000001181",
language = "English (US)",
volume = "4",
journal = "Plastic and Reconstructive Surgery - Global Open",
issn = "2169-7574",
publisher = "Lippincott Williams and Wilkins Ltd.",
number = "12",

}

TY - JOUR

T1 - Surgical site infiltration for abdominal surgery

T2 - A novel neuroanatomical-based Approach

AU - Joshi, Girish P

AU - Janis, Jeffrey E.

AU - Haas, Eric M.

AU - Ramshaw, Bruce J.

AU - Nihira, Mikio A.

AU - Dunkin, Brian J.

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. Methods: Literature searches were conducted for studies reporting the neuroana-tomical sources of pain after abdominal surgery. Also, studies identified by preceding search were reviewed for relevant publications and manually retrieved. Results: Based on neuroanatomy, an optimal surgical site infiltration technique would consist of systematic, extensive, meticulous administration of local anesthetic into the peritoneum (or preperitoneum), subfascial, and subdermal tissue planes. The volume of local anesthetic would depend on the size of the incision such that 1 to 1.5mL is injected every 1 to 2cm of surgical incision per layer. It is best to infiltrate with a 22-gauge, 1.5-inch needle. The needle is inserted approximately 0.5 to 1cm into the tissue plane, and local anesthetic solution is injected while slowly withdrawing the needle, which should reduce the risk of intravascular injection. Conclusions: Meticulous, systematic, and extensive surgical site local anesthetic infiltration in the various tissue planes including the peritoneal, musculofascial, and subdermal tissues, where pain foci originate, provides excellent postoperative pain relief. This approach should be combined with use of other nonopioid analgesics with opioids reserved for rescue. Further well-designed studies are necessary to assess the analgesic efficacy of the proposed infiltration technique.

AB - Background: Provision of optimal postoperative analgesia should facilitate postoperative ambulation and rehabilitation. An optimal multimodal analgesia technique would include the use of nonopioid analgesics, including local/regional analgesic techniques such as surgical site local anesthetic infiltration. This article presents a novel approach to surgical site infiltration techniques for abdominal surgery based upon neuroanatomy. Methods: Literature searches were conducted for studies reporting the neuroana-tomical sources of pain after abdominal surgery. Also, studies identified by preceding search were reviewed for relevant publications and manually retrieved. Results: Based on neuroanatomy, an optimal surgical site infiltration technique would consist of systematic, extensive, meticulous administration of local anesthetic into the peritoneum (or preperitoneum), subfascial, and subdermal tissue planes. The volume of local anesthetic would depend on the size of the incision such that 1 to 1.5mL is injected every 1 to 2cm of surgical incision per layer. It is best to infiltrate with a 22-gauge, 1.5-inch needle. The needle is inserted approximately 0.5 to 1cm into the tissue plane, and local anesthetic solution is injected while slowly withdrawing the needle, which should reduce the risk of intravascular injection. Conclusions: Meticulous, systematic, and extensive surgical site local anesthetic infiltration in the various tissue planes including the peritoneal, musculofascial, and subdermal tissues, where pain foci originate, provides excellent postoperative pain relief. This approach should be combined with use of other nonopioid analgesics with opioids reserved for rescue. Further well-designed studies are necessary to assess the analgesic efficacy of the proposed infiltration technique.

UR - http://www.scopus.com/inward/record.url?scp=85052649461&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85052649461&partnerID=8YFLogxK

U2 - 10.1097/GOX.0000000000001181

DO - 10.1097/GOX.0000000000001181

M3 - Article

C2 - 28293525

AN - SCOPUS:85052649461

VL - 4

JO - Plastic and Reconstructive Surgery - Global Open

JF - Plastic and Reconstructive Surgery - Global Open

SN - 2169-7574

IS - 12

M1 - e1181

ER -