Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial

Abstract

Purpose A prospective randomized clinical trial was carried out to observe the analgesic efficacy of ropivacaine for postoperative pain following thoracolumbar spinal surgery. Methods Seventy-one patients with elective posterior thoracolumbar spinal surgery were randomly divided into two groups. Local group received 0.33 % ropivacaine by pump through the wound, and intravenous group received flurbiprofen axetil, pentazocine and palonosetron via intravenous pump. We evaluated the level of pain, the incidence of adverse reactions at 2, 4, 6, 12, 24, 36 and 48 h after operation, and the occurrence of chronic pain 3 months later. Results There were no significant differences in the pain level between the two groups. However, the incidence of nausea, vomiting and chronic pain was significantly lower in the local group. Conclusions Our results showed that local infusion of ropivacaine achieved similar analgesic effects to intravenous delivery of analgesic drugs, but significantly reduced incidence of nausea, vomiting and chronic pain.

Local anaesthetics and regional anaesthesia versus conventional analgesia for preventing persistent postoperative pain in adults and children

“…Only seven studies performed a formal intention-to-treat analysis (Albi-Feldzer 2013; Kairaluoma 2006; Karmakar 2014; Kurmann 2015; Singh 2007; Sprung 2006; Terkawi 2015b). In four studies, there was no attrition at all (Comez 2015; Grigoras 2012; ; ; Weber 2007; Xu 2017). …”

“…Some reported double blinding but did not provide details (Bell 2001; Comez 2015; Paxton 1995; Pinzur 1996). Six studies described out-come assessor blinding, without detail on personnel or participant blinding (Burney 2004; Dogan 2016; Ibarra 2011; Lam 2015; Lavand’homme 2005; O’Neill 2012), but nine other studies neither described nor confirmed it (Bell 2001; Choi 2016; Katsuly-Liapis 1996; Liu 2015; Lu 2008; Okur 2016; Wodlin 2011; Xu 2017; Zhou 2016). …”

“…There was a trend toward more adequate addressing of incomplete outcome data in more recent studies (Albi-Feldzer 2013; Bell 2001; Blumenthal 2005; Brown 2004; Can 2013; Comez 2015; Dogan 2016; Fassoulaki 2000; Fassoulaki 2005; Fassoulaki 2016; Gacio 2016; Grigoras 2012; Gundes 2000; Gupta 2006; Kairaluoma 2006; Karanikolas 2006; Karmakar 2014; Kurmann 2015; Lavand’homme 2007; McKeen 2014; Mounir 2010; O’Neill 2012; Okur 2016; Purwar 2015; Shahin 2010; Singh 2007; Sprung 2006; Terkawi 2015b; Vrooman 2015; Weber 2007; Xu 2017). compared to those that are older (Katsuly-Liapis 1996; Katz 1996; Katz 2004; Lavand’homme 2005; Paxton 1995; Senturk 2002).…”

“…Null bias might cause studies to underestimate the benefit of regional anaesthesia for the prevention of persistent pain after surgery, if the regional anaesthesia interventions were not effectively delivered (Higgins 2011a; Woods 1995). Indeed, a number of included studies reported no improved pain control in the immediate postoperative period in the experimental (regional anaesthesia) group, as evidenced by inconsequential differences in pain scores between groups perioperatively, or similar requirements of rescue analgesic medications between groups in the immediate postoperative period (Barkhuysen 2010; Baudry 2008; Bollag 2012; Can 2013; Choi 2016; Fassoulaki 2000; Ibarra 2011; Ju 2008; Karmakar 2014; Katz 1996; Lam 2015; Lee 2013; Liu 2015; Loane 2012; McKeen 2014; Micha 2012; Purwar 2015; Singh 2013; Smaldone 2010; Terkawi 2015b; Vrooman 2015; Xu 2017; Zhou 2016). Two review authors therefore extracted information on null bias for each included study and documented their judgement with supporting evidence (see: Characteristics of included studies).…”

Drug delivery systems for prolonged duration local anesthesia

“…In current practice, prolonged nerve blockade can be achieved by repeated injections or by placement of indwelling catheters for continuous infusions of drugs. [8,9] Both approaches are resource intensive, necessitating skilled personnel for administration, adjustment of drug levels, and monitoring of drug effects – both intended (pain relief) and unintended (cardiorespiratory effect). This level of effort and monitoring may require hospitalization and requires patients to be tethered to external devices, which presents a risk of infection.…”