Forastiere, E., Sofra, M., Giannarelli, D., Fabrizi, L., & Simone, G. (2008). Effectiveness of continuous wound infusion of 0.5% ropivacaine by On-Q pain relief system for postoperative pain management after open nephrectomy. British Journal of Anaesthesia, 101(6), 841–847.

To compare, after open nephrectomy, the efficacy of continuous wound site infusion with ropivacaine with that of saline; to examine morphine consumption, side effects, bowel function, and hospital length of stay in two study arms

Patients received continuous surgical wound site infusion of either 0.5% ropivacaine or 0.9% saline. For breakthrough pain, all patients received standard care with PCA morphine and ketorolac.

• The sample was composed of 168 patients.
• The age range of patients was 47–71 years. In the ropivacaine group, the mean age was 58.7 years. In the saline group, the mean age was 60.2 years.
• Of all patients, 61% were females and 38.1% were males.
• During the study all patients underwent open nephrectomy through lumbotomic access. Authors did not report underlying diagnoses.

• Single site
• Inpatient
• Rome, Italy

Prospective randomized, double-blinded, placebo-controlled study

• Visual analog scale, 0–10 score, to measure incident pain at mobilization
• Consumption of PCA morphine
• Time to bowel recovery
• Level of sedation
• Length of hospital stay

• Pain at rest and while coughing was significantly less (p < 0.0001) in the ropivacaine group than in the control group.
• Morphine consumption was significantly greater in the control group than in the ropivacaine group. Mean total morphine consumption was significantly greater in the control group (p < 0.0001).
• Compared to the control group, time to bowel recovery was significantly shorter and sedation was less in the ropivacaine group (p < 0.0001).
• Time to discharge was 3.2 days in the control group versus 2.1 days in the ropivacaine group (p < 0.001).
• Use of ropivacaine resulted in substantial cost savings per patient, primarily because ropivacaine was associated with shorter length of stay.

Continuous wound infusion with ropivacaine improved pain relief and accelerated recovery and discharge.

A single surgeon peformed all procedures and placed all catheters. Because of the various locations of nociceptive receptors, this makes generalizing study findings questionable; placement of catheters for local infusion relates to results.

Multimodal pain management that includes continuous wound infusion of anesthetic and systemic opioid can reduce postoperative pain, thereby reducing length of stay and hospitalization costs.