Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland
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Randomized Controlled Trial
Randomized clinical trial of the influence of local subcutaneous infiltration vs subcutaneous and deep infiltration of local anaesthetic on pain after appendicectomy.
Local anaesthesia is commonly used to provide pain relief after surgery. The aim of this randomized, blinded prospective trial was to evaluate whether local subcutaneous and deep infiltration of local anaesthetic provides better postoperative pain control than subcutaneous infiltration alone. ⋯ Both methods of administration of local anaesthetic produced consistently low pain scores in the first 24 h after appendicectomy. There may be additional benefit in a local nerve field blockade in combination with local anaesthetic skin infiltration.
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The study set out to analyse the outcomes of an evolving accelerated recovery programme after laparoscopic colorectal resection (LCR). ⋯ Laparoscopic surgery utilizing IV paracetamol and TAP blocks for postoperative analgesia aids safe effective 'accelerated recovery' in an unselected patient population undergoing right hemicolectomy and high anterior resection. Routine epidural anaesthesia is unnecessary for LCR. Morphine PCA is associated with delayed recovery.
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The use of epidural analgesia is considered fundamental in Enhanced Recovery Protocols. However its value in the perioperative management of laparoscopic colorectal surgical patients is unclear and analgesic regimens vary. The aim of this systematic review was to examine the effects of various analgesic regimes on outcomes following laparoscopic colectomy. ⋯ There is a paucity of data assessing the benefits of postoperative analgesic regimes following laparoscopic colorectal surgery and none of the protocols were shown to be clearly superior. Further studies, including the assessment of spinal analgesia are required to determine the most appropriate analgesic regime following laparoscopic colorectal surgery.