Infiltrations cicatricielles en chirurgie digestive : pourquoi, quand et comment ?

Regional analgesic techniques provide better analgesia and faster postoperative recovery after abdominal surgery as compared to parenteral opiates. Surgical site infusion (SSI) consists in continuous administration of a local anesthetic solution into the surgical wound. SSI should be considered as one of the components of global multimodal strategy. It is a very simple technique, safe, and well-tolerated, that could be indicated in almost all patients. The expected efficacy of SSI is based on the recognition of parietal pain as the major component of the overall postoperative pain after abdominal surgery. Additionally, the evolution of surgical techniques toward less invasive procedures and ambulatory care should be supported by the application of minimally invasive analgesic strategies such as SSI. The benefits of SSI on pain relief and recovery have been demonstrated after median laparotomy, subcostal incisions as well as nephrectomy. Numerous factors may influence the efficacy of SSI. Among these factors, the catheter location inside the deep layers of the abdominal wall (preperitoneal position) seems of major importance. SSI can be viewed as a safe and efficient alternative to epidural analgesia with a favorable benefit-risk ratio in many surgical procedures.