Anesthesiology’s journal-based CME program is open to all readers. Members of the American Society of Anesthesiologists participate at a preferred rate, but you need not be an ASA member or a journal subscriber to take part in this CME activity. Please complete the following steps:
Read the article by Beaussier et al. entitled “Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal surgery: A randomized, double-blind, placebo-controlled study” on page 461 and the accompanying editorial by Kehlet and Liu entitled “Continuous local anesthetic wound infusion to improve postoperative outcome: Back to the periphery?” on page 369 of this issue.
Review the questions and other required information for CME program completion (published in both the print and online journal).
When ready, go to the CME Web site: http://www.asahq.org/journal-cme. Submit your answers, form of payment, and other required information by December 31 of the year following the year of publication.
The American Society of Anesthesiologists is approved by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor continuing medical education programs for physicians.
The American Society of Anesthesiologists designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit™ . Physicians should only claim credit commensurate with the extent of their participation in the activity.
Purpose: The focus of the journal-based CME program, and the articles chosen for the program, is to educate readers on current developments in the science and clinical practice of the specialty of Anesthesiology.
Target Audience: Physicians and other medical professionals whose medical specialty is the practice of anesthesia.
Learning Objectives: After reading this article, participants should have a better understanding of the effectiveness of continuous preperitoneal local anesthetic infusion for postoperative pain control.
Disclosure Information:
Authors – Marc Beaussier, M.D., Ph.D., Hanna El’Ayoubi, M.D., Eduardo Schiffer, M.D., Maxime Rollin, M.D., Yann Parc, M.D., Ph.D., Jean-Xavier Mazoit, M.D., Ph.D., Louisa Azizi, M.D., Pascal Gervaz, M.D., Serge Rohr, M.D., Ph.D., Celine Biermann, M.D., André Lienhart, M.D., Ph.D., and Jean-Jacques Eledjam, M.D., Ph.D. Grants or research support: Supported by a grant from AstraZeneca, Rueil Malmaison, France.
Consultantships or honoraria: None
Authors – Henrik Kehlet, M.D., and Spencer S. Liu, M.D. Grants or research support: Dr. Kehlet has received a grant from AstraZeneca, Södertälje, Sweden, to study wound infusion of local anesthetics in knee and hip replacement.
Consultantships or honoraria: Dr. Liu is a consultant to Anesiva, San Francisco, California.
Question Writers – Peter L. Bailey, M.D., and Leslie C. Jameson, M.D. Drs. Bailey and Jameson have no grants, research support, or consultant positions, nor do they receive any honoraria from outside sources, which may create conflicts of interest concerning this CME program.
Article Questions
Based on the article by Beaussier et al. entitled “Continuous preperitoneal infusion of ropivacaine provides effective analgesia and accelerates recovery after colorectal http://content.wkhealth.com/linkback/openurl?issn=0003–3022&volume=107&issue=3&spage=369&part=fulltextsurgery: A randomized, double-blind, placebo-controlled study” and http://content.wkhealth.com/linkback/openurl?issn=0003–3022&volume=107&issue=3&spage=461&part=fulltextits accompanying editorial by Kehlet and Liu entitled “Continuous local anesthetic wound infusion to improve postoperative outcome: Back to the periphery?” in the September issue of Anesthesiology, choose the one correct answer for each question:
1. Which of the following statements about infusion of local anesthetic at the surgical incision site for open colorectal surgery is most likely true?
A. Randomized controlled trials assessing effectiveness have not been performed.
B. Mental function is impaired.
C. The wound infection rate is similar to rates in patients without catheters.
D. Patients are resistant to using the technique.
2. Which statement comparing use of a continuous preperitoneal infusion of ropivacaine in combination with patient-controlled analgesia (PCA) morphine to PCA morphine alone for pain control in patients undergoing open colorectal surgery is most likely true?
A. PCA morphine alone provides better analgesia during coughing.
B. The combined therapy is associated with significant reductions in morphine consumption.
C. The combined therapy is associated with significantly more postoperative nausea and vomiting.
D. Six weeks after surgery, combined therapy is associated with significantly more residual wound pain.
3. Which of the following statements about the preperitoneal infusion of ropivacaine in patients undergoing open colorectal surgery is most likely true?
A. The local anesthetic is found only in tissue in the subdermal area of the incision.
B. The cost of related disposable equipment exceeds $750 (US).
C. Plasma concentrations of ropivacaine are greater after 48 h than after 24 h of infusion.
D. Patients do not develop symptoms of local anesthetic toxicity.
4. Which statement comparing use of a continuous preperitoneal infusion of ropivacaine in combination with patient-controlled analgesia (PCA) morphine to PCA morphine alone for pain control in patients undergoing open colorectal surgery is most likely true?
A. Length of hospital stay is decreased
B. Time to return of bowel function is similar
C. Time to postanesthesia care unit discharge is prolonged (Aldrete score of 8)
D. Quality of sleep is similar
5. Which statement about the effectiveness of preperitoneal infusion of local anesthetic is most likely true?
A. It effectively blocks pain receptors on the peritoneum.
B. Superficial placement of the catheter provides better pain relief than preperitoneal placement after open abdominal surgery.
C. The combined technical failure rate of the catheter and the pump is 10%–20%.
D. It is not effective for treatment of incisional pain after a cholecystectomy.
