High-volume, multilevel local anesthetics–Epinephrine infiltration in kyphoscoliosis surgery

Abstract

Background and Aims: Local anesthetic (LA) infiltration is one of the analgesic techniques employed during scoliosis correction surgery. However, its efficacy is controversial. In the present study for optimizing analgesia using the infiltration technique, we proposed two modifications; first is the preemptive use of high volume infiltration, second is applying three anatomical multilevel infiltrations involving the sensory, motor, and sympathetic innervations consecutively. Material and Methods: This prospective study involved 48 patients randomized into two groups. After general anesthesia (GA), the infiltration group (I) received bupivacaine 0.5% 2 mg/kg, lidocaine 5 mg/kg, and epinephrine 5 mcg/mL of the total volume (100 mL per 10 cm of the wound length) as a preemptive infiltration at three levels; subcutaneous, intramuscular, and the deep neural paravertebral levels, timed before skin incision, muscular dissection, and instrumentation consecutively. The control group (C) received normal saline in the same manner. Data were compared by Mann-Whitney, Chi-square, and t -test as suitable. Results: Intraoperatively, the LA infiltration reduced fentanyl, atracurium, isoflurane, nitroglycerine, and propofol consumption. Postoperatively, there was a 41% reduction in morphine consumption, longer time to the first analgesic request, lower VAS, early ambulation, and hospital discharge with high-patient satisfaction. Conclusion: The preemptive, high-volume, multilevel infiltration provided a significant intra and postoperative analgesia in scoliosis surgery.

Perioperative pain management for spine surgeries

“…LA infiltration by a surgeon before wound closure is a quick and inexpensive way to provide pain relief. In some spine surgery studies, it has been shown to be effective, 70,71 but a definite conclusion cannot be drawn due to heterogeneity and a lack of robust data 72 . In recent studies, PNBs have outshone LA infiltration in this matter 73,74 .…”

“…Erector spinae plane block [47][48][49][50][51][52][53] Most studied block in adult spine surgeries Associated with reduced opioid consumption intraoperatively and postoperatively, lower pain scores, less NV and better patient satisfaction More comparative effectiveness studies are required Most studied block in pediatric spine surgeries Associated with reduced opioid consumption intraoperatively and postoperatively, lower pain scores, less NV and better patient satisfaction More comparative effectiveness studies are required Thoracolumbar interfascial plane block [56][57][58][59] Limited studies with mixed results Not studied Midpoint transverse process to pleura block 45,46 Inadequate data Not studied Quadratus lumborum block 60 Single retrospective study Can be used for anterior and posterior approach lumbar spine surgeries Not studied Surgical infiltration [67][68][69][70][71][72][73][74]…”