Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?

Abstract

SummaryObjective. Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery.Methods. We employed perioperative intra-and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra-and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded.Results. There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p= 0,006). The cumulative dolantine dose was also significantly lower in the facet group (p= 0,001) Conclusion. The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.KEY WORDS: Analgesia. Facet joint infiltration. Discopathy. Lumbar surgery.¿Puede reducirse el dolor postoperatorio en la cirugía discal degenerativa lumbar con infiltración de analgésicos? ResumenObjetivo. La analgesia peroperatoria influye en el curso del dolor postquirúrgico. El propósito del estudio reside en la evaluación de la posible relación entre el consumo de dolantina y otros analgésicos en el control del dolor postquirúrgico de origen facetario lumbar en la enfermedad discal degenerativa.Métodos. Empleamos peroperatoriamente infiltraciones percutáneas de bupivacaína intra y perifacetaria para reducir el dolor postoperartorio tras cirugía discal lumbar. El estudio fue randomizado y oculto al observador y se realizó sobre 40 pacientes operados de cirugía electiva por enfermedad degenerativa lumbar, con una situación general Clase I-II de la clasificación de la American Society of Anesthesiologist. Los pacientes se dividieron en dos grupos de 20 .El Grupo 1 se le administró bupivacaína en el tejido subcutáneo y capas musculares. El grupo 2 recibió una inyección adicional de bupivacaína intra y perifacetaria. Durante el postoperatorio, los pacientes, dispusieron de una bomba programable de analgesia controlada, que se activó exclusivamente a demanda para infundir dolantina en las 24 horas siguientes a la operación. En la Unidad de Reanimación postquirúrgicas se recogieron las necesidades de dolantina de los distintos pac...

Reduction of Opioid Consumption after Major Spinal Surgery without Neurological Impairment by Block of Rami Dorsales

“…Our results go with Bademci's findings concerning the postoperative opioid sparing effect of intra-operative infiltration of bupivacaine to facet joints and to overlying tissues in lumbar disc surgery [10]. Furthermore our technique of blocking rami dorsales including ramus lateralis provides sufficient analgesia for muscles, hypodermis and dermis without an additional infiltration of bupivacaine into these tissues.…”