Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain

Local anesthetic infiltration prior to surgical incision closure is a frequently used technique in the operating room. Debate continues, with clinicians, as to the effectiveness of this technique in pain reduction. A literature review using PubMed with the criteria of "local anesthetic infiltration and pain reduction" was conducted for the use of local anesthetic infiltration prior to surgical closure. The search provided 137 results that were then categorized and reviewed, the studies that reviewed the effectiveness (pain reduction) of single dose infiltration of local anesthetics into the surgical wound was small, only numbering 23 studies. The use of local anesthetics before surgical incision or a continuous infusion of the local anesthetics into the surgical wound in the immediate post-operative period is more widely studied, but the effectiveness of this practice varies greatly between studies. The efficacy of using a single pre-closure local anesthetic infiltration ranged from producing a modest reduction in post-surgical pain to no change in post-surgical pain. This systematic review revealed that few studies have examined the effectiveness of local anesthetic infiltration into surgical incisions on post-operative pain outcomes and these results vary greatly as to the effectiveness of this surgical practice.