Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis

Yao Yun-Tai; More Aditya; Chao Mark; Huang Shuo

doi:10.1016/j.cmsj.2026.07.003

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Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis

Chinese Medical Sciences Journal Vol. 41, Issue 2, Pages: 88-98(2026)

Research Article | Updated：2026-10-16

- Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis
- Affiliations：
  
  Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
  Evidence in Cardiovascular Anesthesia (EICA) Group, Beijing 100037, China
  Center of Outcomes Research, Department of Anesthesiology, Critical Care and Pain Medicine, University of Texas, Houston 77030, TX, United States
  Outcomes Research Consortium, Houston 77030, TX, United Statesa Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
- Author bio：
  
  Corresponding author. E-mail: yuntaiyao@126.com (Y.-T. Yao).
- Funds：
- DOI：10.1016/j.cmsj.2026.07.003
  CLC：
- Published：2026-06
- Accepted：
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Yao Yun-Tai, More Aditya, Chao Mark, et al. Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis[J]. Chinese Medical Sciences Journal, 2026, 41(2): 88-98.
DOI：

Yao Yun-Tai, More Aditya, Chao Mark, et al. Continuous wound infiltration with local anesthetics in adult patients undergoing cardiac surgery: A PRISMA-compliant systematic review and meta-analysis[J]. Chinese Medical Sciences Journal, 2026, 41(2): 88-98. DOI： 10.1016/j.cmsj.2026.07.003.

摘要

Abstract

Background:

Effective postoperative analgesia is critical to recovery after cardiac surgery. Continuous wound infiltration (CWI) with local anesthetics (LAs) has been proposed as an opioid-sparin

g adjunct

but its efficacy beyond pain control and its safety profile remain incompletely defined.

Methods:

We conducted a PRISMA-compliant systematic review and meta-analysis of randomized controlled trials (RCTs) comparing CWI with control in adult cardiac surgery. PubMed

Embase

and Cochrane CENTRAL were searched from inception to August 30

2025

and updated on April 2

2026. Primary outcomes were postoperative Visual Analogue Scale (VAS) pain scores and cumulative morphine consumption. Secondary outcomes included mechanical ventilation duration

length of stay

mortality

complications

patient satisfaction

and adverse events. Risk of bias was assessed using the Cochrane RoB 2.0 tool

and certainty of evidence was evaluated using Grading of Recommendations Assessment

Development and Evaluation (GRADE).

Results:

Twelve RCTs involving 2

117 patients were included. CWI significantly reduced VAS during mobilization at 24 h (MD = -0.93

95% confidence interval [

]

: -1.53--0.33

= 0.002) and 48 h (MD = -0.80

95%

: -1.17--0.44

＜ 0.001)

and decreased 48-hour morphine consumption (MD = -8.10 mg

95%

: -13.41--2.79

= 0.003). No significant effects were observed on VAS at rest

mechanical ventilation duration

ICU or hospital length of stay

mortality

or major cardiovascular

pulmonary

renal

gastrointestinal complications

or postoperative infections. Patient satisfaction was higher with CWI. Technical complications were uncommon

and no clinically significant LA toxicity was reported.

Conclusions:

In adult cardiac surgery

CWI with LAs modestly improves analgesia during mobilization and reduces opioid requirements without clear improvement in major clinical outcomes or length of stay. CWI appears safe and feasible and may serve as an adjunct in multimodal

opioid-sparing analgesia strategies. Further adequately powered trials are warranted to de

fine its comparative effectiveness within contemporary enhanced recovery after surgery pathways.

关键词

Keywords

references

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