Influence of Epidural Ropivacaine with or without Dexmedetomidine on Postoperative Analgesia and Patient Satisfaction after Thoraco-Lumbar Spine Instrumentation: A Randomized, Comparative, and Double-Blind Study

Abstract

This was a prospective, randomized, and double-blind study. Purpose: Thoraco-lumbar spine surgery is associated with severe postoperative pain and can cause chronic pain. We aimed to compare the impact of epidural ropivacaine with and without dexmedetomidine on postoperative analgesia after thoracolumbar spine instrumentation wherein an epidural catheter was placed by the surgeon intraoperatively. Overview of Literature: Very few studies have reported the use of epidural dexmedetomidine in spine surgeries. When used via the epidural route, dexmedetomidine is safe and efficacious and is associated with reduced rescue analgesia consumption, increased duration of analgesia, reduced pain scores, but not with major hemodynamic adverse effects. Methods: Total 60 American Society of Anesthesiologists I-III adult patients aged 18-65 years who were scheduled to undergo thoraco-lumbar spine instrumentation were randomly allocated into group RD (epidural ropivacaine+dexmedetomidine) or group R (epidural ropivacaine plus saline). We aimed to compare the total rescue analgesic consumption on postoperative day 0, 1, and 2. Moreover, we studied the time to first rescue analgesia with visual analogue scale score <4 and the overall patient satisfaction scores. Results: There was no difference between the demographic characteristics of the two groups. The mean value of total rescue analgesia consumption was 162.5±68.4 mg in the RD group and 247.5±48.8 mg in the R group. The mean time to first rescue analgesia was 594.6±83.0 minutes in the RD group and 103.6±53.2 minutes in the R group. The mean patient satisfaction score was 4.2±0.7 in the RD group and 3.2±0.6 in the R group. No patient had any respiratory depression or prolonged motor blockade during the postoperative period. Conclusions: This study demonstrated the superior efficacy, in terms of postoperative analgesia and patient satisfaction scores, of epidural ropivacaine plus dexmedetomidine over that of ropivacaine alone in patients undergoing surgery for thoraco-lumbar spine.

Dexmedetomidine vs hyaluronidase addition to fluoroscopy-guided caudal analgesia with steroid in lumbosacral spine surgery. A comparative double blinded study

“…Pain-relieving effect of epidural dexmedetomidine as a sole adjuvant has been searched in different surgeries: orthopedic, abdominal and spine surgeries [17][18][19][20]. A study done in our university hospitals in 2019 by Alansary et al [21] showed that addition of 50 µg dexmedetomidine to epidural bupivacaine provided better postoperative pain control than addition of 50 µg fentanyl in lumbar disc operations.…”

“…As mentioned, studies demonstrated that dexamethasone and dexmedetomidine can prolong duration of epidural analgesia after spine surgeries when used as sole agents [16,20]. The mechanism by which each drug increase the duration of local anesthetics is not completely known but different actions of these drugs have been documented.…”

Lumbar Spinal Stenosis: Review Update 2022

“…Epidural steroid injection is indicated for acute radiating pain and nervous claudication that are interfering with daily life despite pain relievers and rest, which are expected to improve symptoms [45]. In addition, research on the use of ropivacaine and dexmedetomidine as well as epidural neuroplasty in conjunction with thoracolumbar surgery has been recently published [46,47]. Epidural neuroplasty is employed to alleviate back discomfort and/or radiating pain caused by mechanical compression of the intravertebral nerve structures or neuroinflammation.…”

Effect of gelfoam soaked epidural dexmedetomidine or bupivacaine for postoperative analgesia in lumbar laminectomy: A prospective randomized clinical study

“…[ 1 ] Inadequate postoperative pain relief may lead to increased morbidity and mortality and may delay recovery. [ 2 ] Nonsteroidal anti-inflammatory drugs or opioids are commonly used for postoperative pain in spine surgeries but are associated with side effects and wide variations in their clinical effects. Epidural analgesia is an effective and safe method in spine surgeries to avoids unwanted side effects.…”

“…[ 9 ] Although the use of dexmedetomidine has been extensively studied for postoperative epidural analgesia with epidural catheter in situ. [ 2 10 ] Still, there have been no studies on epidural administered gelfoam soaked dexmedetomidine to enhance postoperative analgesia. Thus, this study was to evaluate the effectiveness of drugs such as dexmedetomidine or bupivacaine in the form of soaked gelfoam placed over epidural space for postoperative analgesia.…”