Bupivacaine Field Block With Clonidine for Postoperative Pain Control in Posterior Spine Approaches: A Randomized Double-Blind Trial

Hay, Joe Abdel; Kobaïter-Maarrawi, Sandra; Tabet, Patrick; Moussa, Ronald; Rizk, T.; Nohra, G.; Okais, N; Samaha, Elie; Maarrawi, Jospeh

doi:10.1093/neuros/nyx313

Cited by 11 publications

(4 citation statements)

References 32 publications

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“…One randomized double-blinded placebo-controlled trial, including 120 patients with posterior lumbar spine surgery, evaluated wound infiltration with bupivacaine combined with local methylprednisolone versus placebo and demonstrated significantly improved postoperative analgesic management (reduction in opioid utilization, lower pain scores, and higher patient satisfaction) [183]. Continuous infiltration using a wound catheter provides good pain relief for up to 48 hours [182,184] and adding dexmedetomidine or clonidine (a2-agonists) to topical local anesthetics (bupivacaine or ropivacaine) increases the effectiveness of wound infiltration [185,186].…”

Section: Quality Of Evidence: Lowmentioning

confidence: 99%

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

et al. 2021

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BACKGROUND: Enhanced Recovery After Surgery (ERAS) evidence-based protocols for perioperative care have led to improvements in outcomes in numerous surgical areas, through multimodal optimization of patient pathway, reduction of complications, improved patient experience and reduction in the length of stay. ERAS represent a relatively new paradigm in spine surgery. PURPOSE: This multidisciplinary consensus review summarizes the literature and proposes recommendations for the perioperative care of patients undergoing lumbar fusion surgery with an ERAS program.FDA device/drug status: not applicable.

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Section: Quality Of Evidence: Lowmentioning

confidence: 99%

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

et al. 2021

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“…The synergistic effect of clonidine with bupivacaine, well-established in peripheral nerve blocks, remains controversial in local field block for postoperative analgesia despite resulting in better and prolonged postoperative analgesia in posterior lumbar spine surgeries [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Wound Infiltration with Levobupivacaine, Ketorolac, and Adrenaline for Postoperative Pain Control after Spinal Fusion Surgery

et al. 2021

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This study enrolled patients in from a single center who underwent primary spinal fusion procedure and divided them into two groups (group-control study). Purpose: Good local infiltration can reduce postoperative analgesic requirements and enable expedited discharge. Administration of a combination of levobupivacaine (200 mg/100 mL, 0.9% N-Saline), ketorolac (30 mg), and adrenaline (0.5 mg) as a wound infiltrate is recommended at an optimum combination. Overview of Literature: There is currently no consensus on the optimum intraoperative local infiltration of spinal surgery patients undergoing operative fusion. Methods: Patients who were enrolled in two spinal centers (over 24 months) undergoing primary spinal fusion procedures were allocated into two groups, comparing the type of local infiltration used at the time of the procedure. Group 1 received the combination of levobupivacaine (200 mg), ketorolac (30 mg), and adrenaline (0.5 mg), while group 2 received other types of local anesthetics. Primary outcome measures include patient-controlled analgesia (PCA) use, morphine consumption, and length of hospital stay. Secondary outcome measure are as follows: days of physiotherapy, pain score, side effects, and complications. Results: There are a total of 140 patients enrolled. Seventy-five patients enrolled were allocated to group 1, receiving the study combination, and 65 patients were assigned in group 2, receiving other local infiltrations. All primary outcome measures (consumption of morphine, use of PCA, and length of stay) were significantly higher in group 2 than the study combination (p<0.05). The secondary outcomes of pain scores and days of physiotherapy values were also significantly higher in group 2 (p<0.05). Patient satisfaction questionnaires gave significantly better results in group 1 (p<0.05). There were no significant statistical differences with regard to any postoperative complications between the two groups. Conclusions: Our data suggest that the studied wound infiltration is a safe and feasible option that could provide good postoperative pain control without significant side effects. It also allowed to reduce dependence of opioids and PCA, earlier postoperative mobilization, lower pain scores postoperatively, and reduced hospital stay.

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“…Opioid, nonsteroidal anti‐inflammatory agents, and persistent epidural analgesia have been routinely employed to control postoperative pain. 4 , 5 , 6 So far, continuous epidural analgesia has been the most popular treatment since it is more effective than IV analgesic in pain. 7 Nevertheless, a number of side effects, for example, nausea, vomiting and hypotension, have restricted the wide application of the product in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, proper pain management is crucial to increase the degree of satisfaction of the patient, as well as the reduction in the cost and time of hospitalization. Opioid, nonsteroidal anti‐inflammatory agents, and persistent epidural analgesia have been routinely employed to control postoperative pain 4–6 . So far, continuous epidural analgesia has been the most popular treatment since it is more effective than IV analgesic in pain 7 .…”

Section: Introductionmentioning

confidence: 99%

Effect of wound infiltration of dexmedetomidine in lumbar spine surgery on postoperative wound pain: A meta‐analysis

Wang,

Peng,

et al. 2023

International Wound Journal

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In a meta‐study, we evaluated the effectiveness and security of the combination of topical anaesthetic and dexmedetomidine in the treatment of postoperative pain in patients with lumbar disease. Four databases were systematically searched for possible related articles. Only English‐language research was taken into account on the Internet. Furthermore, we only took into account the studies that were published prior to 2023. Only those that fulfilled the eligibility criteria were considered: (1) in adults who were about to undergo spine operation, (2) dexmedetomidine combined with local anaesthesia, (3) Visual Analog Scale scores at 4 and 24 h after the event and (4) this was a randomized or nonrandomized, controlled study. The meta‐analysis was carried out with Revman 5.3 software. A ROBINS‐I‐based instrument was used to evaluate controlled studies. All trials were synthesized by computing the end results with either a fixed or a random effect model, which was dependent on statistical diversity. Five trials showed a marked reduction in wound pain at 4 h after the operation in patients who were treated with dexmedetomidine for lumbar spinal surgery (MD, −0.81; 95% CI, −1.24, −0.35; p = 0.0005). In the case of lumbar spinal operations, the addition of dexmedetomidine to the postoperative treatment resulted in a marked reduction in the pain at 24 h post‐operation (MD, −0.64; 95% CI, −0.79, −0.48; p < 0.0001). The quality of the data we evaluated was ‘moderate’ to ‘good’; thus, we have limited confidence in the impact estimation, and the actual impact might be significantly different from what we had expected. Additional studies should concentrate on practices that are well known to cause severe postoperative pain, especially for cases where the improvement of pain management may lead to substantial clinical benefits in terms of reduction of morbidity or cost‐effectiveness in terms of quicker healing and release.

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Bupivacaine Field Block With Clonidine for Postoperative Pain Control in Posterior Spine Approaches: A Randomized Double-Blind Trial

Abstract: The addition of clonidine to local preincisional field block with bupivacaine resulted in better and prolonged postoperative analgesia in posterior lumbar spine surgeries, an effect that was more pronounced in patients with no preoperative spinal pain.

Cited by 11 publications

References 32 publications

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

Wound Infiltration with Levobupivacaine, Ketorolac, and Adrenaline for Postoperative Pain Control after Spinal Fusion Surgery

Effect of wound infiltration of dexmedetomidine in lumbar spine surgery on postoperative wound pain: A meta‐analysis

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