Impact of continuous local anesthetic wound infiltration on postoperative outcomes following open radical cystectomy: a comprehensive evaluation.

PURPOSE: To evaluate continuous wound infiltration (CWI) as an alternative to thoracic epidural analgesia (TEA) for postoperative recovery after open radical cystectomy within an ERAS® pathway. MATERIALS AND

METHODS

Retrospective before–after cohort at a Swiss tertiary center using a prospectively maintained ERAS® database (TEA: Nov 2012–May 2016; CWI: Jun 2016–Mar 2024). Adults undergoing open cystectomy with extended pelvic lymphadenectomy and ileal conduit or neobladder were included (CWI = 154; TEA = 88). Outcomes were daily pain (VAS 0–10), nausea, opioid rescue (POD0–3), gastrointestinal recovery (first stool; tolerance of solid food), length of stay (LOS), and 90-day complications. Mixed-effects and multivariable models adjusted for prespecified covariates.

RESULTS

Pain scores were lower with TEA on POD0–3, whereas CWI had less postoperative nausea. CWI showed faster bowel recovery (first stool median 5 vs. 6 days, p = 0.02) and earlier tolerance of solid food (median 5 vs. 11 days, p < 0.001; adjusted β − 4.4 days, 95% CI − 6.8 to − 2.1). LOS was shorter with CWI (median 15 vs. 24 days, p < 0.001; adjusted β − 5.0 days, 95% CI − 9.1 to − 1.0). Early opioid rescue was more frequent with CWI, attenuating by POD3. No CWI catheter-related complications occurred.

CONCLUSION

Within ERAS®, CWI with ropivacaine is a clinically acceptable alternative to TEA after open RC, trading slightly higher early pain for faster gastrointestinal recovery and a shorter LOS.