Preemptive Analgesia with Local Lidocaine Infiltration for Single-Level Open Disc Operation

Abstract

To evaluate the impact of preemptive local analgesia at the incision site for postoperative pain in patients undergoing disc operation. In this prospective, randomized, double-blinded, placebo-controlled study 166 patients were assigned to either lidocaine (n = 83) or placebo (n = 83) groups. The incision site was infiltrated with either 20 mL of 2% lidocaine and 0.9% saline in lidocaine group or 0.9% saline before the incision. Morphine (5 mg) was used for postoperative pain treatment. Postoperative pain was measured with Visual Analog Scale (VAS) in 6, 12, 24 and 48 h. Data were analyzed with SPSS software, using Chi-square and t-tests. The groups were matched for age, sex, type of operation, mean length of hospital stay and mean length of operation. Statistical analysis revealed no significant difference in visual analog scores of pain severity at 6, 12, 24 and 48 h after surgery between lidocaine and placebo groups (6 h: 38.22 +/- 26.87 vs. 34.52 +/- 24.43, p = 0.35; 12 h: 33.26 +/- 28.83 vs. 28.01 +/- 24.71, p = 0.20; 24 h: 26.71 +/- 23.31 vs. 22.85 +/- 22.48, p = 0.27; 48 h 16.35 +/- 10.16 vs. 15.23 +/- 8.90 p = 0.45). The amount of narcotics used post operatively had no meaningful difference in the groups (lidocaine 10.07 +/- 8.24 mg vs. placebo 10.54 +/- 9.31 mg p = 0.73). Preemptive analgesia with lidocaine 2% used subcutaneously before skin incision has no effect in reducing postoperative pain, narcotics demand and duration of hospital stay.

Bilateral Radioscopically Guided Erector Spinae Plane Block for Postoperative Analgesia in Spine Surgery: A Randomized Clinical Trial

“…17,19,22 No significant differences in postoperative pain ratings were observed in the remaining studies analyzed. 18,20,21,[23][24][25] In the same systematic review, decreased opioid consumption also was documented during the first 24 hours after surgery in six studies. However, in most cases, the first dose of analgesic rescue was requested early postoperatively, such that any reduction in cumulative opioid consumption was modest.…”

“…16 Of the nine studies selected, data were collected in only seven on surgical-site pain management after spine surgery. [17][18][19][20][21][22][23][24][25] Of these, in only three was a significant reduction in postoperative pain severity observed, mainly in the first 2 to 4 hours after the procedure, when the infiltration was both preand postincision. 17,19,22 No significant differences in postoperative pain ratings were observed in the remaining studies analyzed.…”

“…Six group 1 patients remained immobilized for 1 day (66.7%), among whom two remained so for 1.5 days (22.2%), while all nine patients in group 2 were mobilized before 24 hours (p ¼ 0.0004). The average hours of hospitalization in the two groups were 40.4 (12-72) and 21.3 hours, [12][13][14][15][16][17][18][19][20][21][22][23][24] respectively (p ¼ 0.0007).…”

Postoperative Pain and Preemptive Local Anesthetic Infiltration in Hallux Valgus Surgery

“…17,34 However in 1 of the studies, lidocaine used subcutaneously before the skin incision had no analgesic effect. 9 We hypothesize that one of the most important factors in preemptive local anesthetic infiltration is the antinociceptive action in deep tissues like muscles, articular capsule, peritoneum or neural root. 7,14,17,19,29,34 The efficiency of postoperative pain reduction seems to be more connected with the blockade of the deep tissue nociceptors rather then superficial ones.…”

Use of a Multifunctional Cocktail for Postoperative Bleeding and Pain Control in Spinal Fusion: A Randomized, Double-blind, Controlled Trial

“…Some studies concluded that local use of lidocaine or bupivacaine could not alleviate postoperative pain after spine surgery. 22,23 Some opposing views hold that LIA with bupivacaine or ropivacaine reduce the cumulated morphine dose and postoperative pain. 24,25 Moreover, ropivacaine is a propyl analogue of bupivacaine with a longer duration of action and lower central nervous system and cardiac toxicity 26 .…”