Date of Award

8-9-2014

Document Type

Open Access Dissertation

Department

Biological Sciences

First Advisor

Sarah M Sweitzer

Abstract

With 73 million surgical procedures annually, acute post-operative pain management is critical to improve patient outcomes and reduce health care costs. Local anesthetic (LA) infiltration prior to surgical incision closure is a frequently used technique in the operating room. This thesis tested the hypothesis that the use of post-incisional infiltration of local anesthetics into surgical incisions will reduce post-operative pain as evidenced by assessing the reduction in post-operative opioids and the Visual Analog Scale (VAS). The first phase of this study was to examine the available literature to determine what evidence existed as to the effectiveness of local anesthetics infiltrated into surgical incisions. A systematic review of the literature revealed that few studies have examined the effectiveness of local anesthetic infiltration into surgical incisions on post-operative pain outcomes and these results varied greatly and did not agree on the effectiveness of the practice. The second phase was to conduct a survey of surgeons, in the state of South Carolina, to better determine what specialties utilized this practice, determine if the beliefs of those who did and did not use this local anesthetic infiltration technique, and to better define a subgroup of patients that would be examined in a retrospective study. A survey of surgeons revealed that approximately 65% of surgeons used local anesthetics injected into the surgical wound at the end of the surgical procedure with 95% of those indicating they believe it reduces surgical pain and 41% indicated that it reduced opioid consumption. In contrast to the high usage of this practice, only 18% of those surveyed believe that this practice is evidenced based. The final, third phase, was a retrospective study of adult

patients that underwent outpatient repair of abdominal hernias done by either an open or laparoscopic surgical techniques. A statistical significant reduction in pain was noted in both the post-operative visual analog scale (p

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