Continuous Local Anesthetic Wound Infiltration Protocol

Catheter Placement and Management

The American College of Surgeons recommends placing continuous local wound infusion catheters in the pre-peritoneal or subcutaneous space above the fascia at the end of surgery, with 0.2% ropivacaine infused at 6 ml/hour for 48 hours to provide effective postoperative analgesia 1, 2
Aspirate the catheter prior to injection to avoid intravascular administration, as recommended by the American Academy of Dermatology 3

The FDA supports maximum dosing of 1 ml/kg of 0.25% bupivacaine (2.5 mg/kg) or 1.5 ml/kg of 0.2% ropivacaine (3 mg/kg) for single-shot wound infiltration in adults, as stated by the Anaesthesia journal 4
For pediatric patients, the maximum dosing is 1 ml/kg of 0.25% bupivacaine (2.5 mg/kg) or 1.5 ml/kg of 0.2% ropivacaine (3 mg/kg) for single-shot wound infiltration, as recommended by the Anaesthesia journal 4

The American Academy of Dermatology recommends using the lowest effective dose to minimize risk of local anesthetic systemic toxicity (LAST) and aspirating before each injection or bolus to prevent intravascular administration 3
Continuously monitor patients for early signs of toxicity, such as perioral numbness, metallic taste, tinnitus, confusion, or seizures, as advised by the American Academy of Dermatology 3
Pre-peritoneal catheters are not associated with increased surgical site infection risk, according to the World Journal of Emergency Surgery 1, 2

Continuous wound infusion significantly decreases visual analog pain scores at rest and with activity at 6, 12, 24, and 48 hours postoperatively, as reported by the World Journal of Emergency Surgery 1, 2
This technique consistently reduces total opioid consumption and rescue analgesic requirements, as stated by the World Journal of Emergency Surgery 1, 2

Do not place catheters in patients with active surgical site infection or systemic sepsis, as recommended by the World Journal of Emergency Surgery 5
Avoid in patients on therapeutic anticoagulation without appropriate risk assessment, as advised by the World Journal of Emergency Surgery 5
Do not exceed maximum dosing limits when combining continuous infusion with other local anesthetic techniques, as recommended by the World Journal of Emergency Surgery 5
Do not abruptly discontinue infusion without transitioning to alternative analgesia, as stated by the World Journal of Emergency Surgery 1, 2