Dr. Anesthesia on Post-Operative Wound Analgesia

Hello, my name is Dr. Anesthesia.

I would like to tell you something about postoperative wound analgesia.



Effective ostoperative analgesia is important from the patient's perspective and can also improve clinical outcomes.
Recent surveys report only modest success in providing suitable analgesia, as 30% to 86% of surgical patients report moderate to severe pain after a surgical procedure.



A promising modality that might help improve postoperative analgesia is the relatively simple technique in which the surgeon directly places a catheter to infuse local anesthetic into wounds at the end of the procedure.


This modality can be widely used, is technically efficient, offers the potential to provide complete analgesia or to substantially reduce the need for opioids and their related side effects, can be used for several days, and can now, with the introduction of new portable pumps, be used on an ambulatory basis.



All wounds have the potential to cause pain, and the nature of the pain varies with the type of wound.

Many factors may exacerbate wound pain, including infection, trauma at dressing changes and poor technique when applying compression therapy.

Failure to assess wound pain or inadequate pain assessment can cause the patient further anguish and extended suffering.


Current knowledge suggests that peripheral inflammation following surgery activates and sensitizes both peripheral and central nervous system.

These phenomena involved in the maintenance of the inflammatory response lead to hypersensibility, hyperalgesia and allodynia. Hyperalgesia participates in the general experience of postoperative pain.

For a long time, local anaesthetics have been used for their capacity to block nociceptive input.

Multiple local anesthetics at concentrations typically used in the clinical setting (e.g., bupivacaine 0.125%-0.75%; lidocaine 1%-3%) inhibit the growth of numerous bacteria and fungi under various conditions.


Different local anesthetics showed various degrees of antimicrobial capacity; bupivacaine and lidocaine, for example, inhibit growth to a significantly greater extent than does ropivacaine.

Greater concentrations, longer exposure, and higher temperature each correlate with a proportional increase in microbial growth inhibition.

Since the introduction of cocaine in 1884, local anesthetics have been used as a mainstay of pain management.


However, numerous studies over the past several decades have elucidated the supplemental role of local anesthetics as antimicrobial agents.

In addition to their anesthetic properties, medications such as bupivacaine and lidocaine have been shown to exhibit bacteriostatic, bactericidal, fungistatic, and fungicidal properties against a wide spectrum of microorganisms.

The 'Heal not Hurt' initiative is an excellent example of the profession and industry working together to implement best practice guidance in patient-centered pain-free wound care in clinical care.

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