Pre-emptive caudal epidural analgesia with ropivacaine for lumbosacral spine surgery: A randomized case control study

Samagh, Navneh; Pai, Raghavendra K; Mathews, Thomas K; Jangra, Kiran; Varma, Ravi Gopal

doi:10.4103/joacp.joacp_72_17

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…The caudal epidural technique is simple, quick to perform, and avoids penetration of the surgical site. Caudal analgesia has been successfully used to provide postoperative analgesia for lumbar spine surgeries 59. Clonidine46 and dexmedetomidine47 administered as adjuvants in the caudal epidural space prolong analgesia.…”

Section: Resultsmentioning

confidence: 99%

“…Lower extremity weakness is an important side effect of caudal injection of local anesthetic, although we were unable to identify a specific study describing its incidence compared with other epidural injections. Some studies report that some local anesthetics (eg, ropivacaine) may provide faster motor recovery after caudal epidural analgesia 59…”

Section: Resultsmentioning

confidence: 99%

“…Caudal analgesia has been successfully used to provide postoperative analgesia for lumbar spine surgeries. 59 Clonidine 46 and dexmedetomidine 47 administered as adjuvants in the caudal epidural space prolong analgesia. Clonidine acts on spinal cord nociceptive neurons directly and on α2 adrenoceptors at spinal and supraspinal sites to produce analgesia.…”

Section: Caudal Analgesiamentioning

confidence: 99%

“…Some studies report that some local anesthetics (eg, ropivacaine) may provide faster motor recovery after caudal epidural analgesia. 59 Regional Nerve Blocks Regional blocks aim to block the transmission of pain signals through the dorsal rami of spinal nerves. 60 The multifidus cervicis plane (MCP) and intersemispinal plane (ISP) blocks 49 have been utilized for surgery in the cervical region, the erector spinae plane (ESP) block 48 for surgery in the thoracic region, and the thoracolumbar interfacial plane block (TLIP) for surgery in the lumbar region.…”

Section: Caudal Analgesiamentioning

confidence: 99%

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Opioid Alternatives in Spine Surgery: A Narrative Review

Rajan

Devarajan

Krishnaney

et al. 2020

Journal of Neurosurgical Anesthesiology

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Adequate analgesia is known to improve outcomes after spine surgery. Despite recent attention highlighting the negative effects of narcotics and their addiction potential, opioids have been the mainstay of management for providing analgesia following spine surgeries. However, side effects including hyperalgesia, tolerance, and subsequent dependence restrict the generous usage of opioids. Multimodal analgesia regimens acting through different mechanisms offer significant opioid sparing and minimize the side effects of individual drugs. Hence, they are being increasingly incorporated into enhanced recovery protocols. Multimodal analgesia includes drugs such as N-methyl-D-aspartate antagonists, nonsteroidal antiinflammatory drugs and membrane-stabilizing agents, neuraxial opioids, local anesthetic infiltration, and fascial compartment blocks. Analgesia started before the painful stimulus, termed preemptive analgesia, facilitates subsequent pain management. Both nonsteroidal anti-inflammatory drugs and neuraxial analgesia have been conclusively shown to reduce opioid requirements after spine surgery, and there is a resurgence of interest in the use of low-dose ketamine or methadone. Neuraxial narcotics offer enhanced analgesia for a longer duration with lower dosage and side effect profiles compared with systemic opioid administration. Fascial compartment blocks are increasingly used as they provide effective analgesia with fewer adverse effects. In this narrative review, we will discuss multimodality analgesic regimens incorporating opioid-sparing adjuvants to manage pain after spine surgery.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Caudal Analgesiamentioning

confidence: 99%

Section: Caudal Analgesiamentioning

confidence: 99%

See 2 more Smart Citations

Opioid Alternatives in Spine Surgery: A Narrative Review

Rajan

Devarajan

Krishnaney

et al. 2020

Journal of Neurosurgical Anesthesiology

View full text Add to dashboard Cite

show abstract

“… 5 In addition, diverse routes of administration of local anesthetic (LA) agents have been studied including local wound infiltration, and regional blocks such as spinal, epidural and paravertebral injections. 6 Since dorsal rami innervate all the pain generators following lumbar spine surgery (LSS), regional anesthetic techniques like Thoraco Lumbar Interfascial Plane (TLIP) Block, Quadratus Lumborum (QL) block, Mid‐point Transverse process to Pleura (MTP) block, and Erector Spinae Plane Block (ESPB) have been developed to target them locally. 7 , 8 , 9 , 10 Among these regional blocks, lumbar ESPB has been widely studied.…”

Section: Introductionmentioning

confidence: 99%