Horizontal Midline Surgery
Mikio Nihira, MD, Professor of Obstetrics, Gynecology, and Geriatrics at the University of Oklahoma Health Sciences Center and Fellowship Director for the Female Pelvic Medicine and Reconstructive Surgery Program demonstrates a systematic infiltration technique for local anesthetic delivery into an abdominal surgical wound.
This case involves a 68-year-old woman with stage 3 anterior apical prolapse. Her condition is complicated by obesity, sleep apnea, and chronic opioid use due to back pain. However, she is an active patient who runs her own business and is an avid golfer. The video highlights an open abdominal sacrocolpopexy performed through a 14 cm suprapubic transverse incision. Preoperatively, she received 300 mg of oral gabapentin; and intraoperatively, she received 1 g of acetaminophen, 15 mg of ketorolac, and 4 mg of dexamethasone.
Clinical Infiltration Pearls from Video Segment
– Aim to inject nearly perpendicular to the plane of the wound
– Try to observe a wheel within the preperitoneal plane
– Inject to a depth of approximately 1 cm; and systematically walk the various planes with the recognition that liposomal bupivacaine, because it is bound to fat cells, does not diffuse very well into the tissue
– Administer as multiple small injections rather than infiltrate with a large or bolus dose, as this approach is not effective