Study of wound instillation technique for effective postoperative analgesia using ropivacaine in lumbar spine surgery

Saini, Dimpal; Yadav, Urvashi

doi:10.4103/aer.aer_87_18

Cited by 4 publications

(2 citation statements)

References 17 publications

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“…For this recommendation, we decided not to distinguish between wound instillation and wound infiltration because these two techniques are closely related. Three RCTs of high quality showed significantly improved outcomes using wound instillation or infiltration [41,42,44]. One RCT did not show a significant analgesic benefit after wound instillation [43].…”

Section: Discussionmentioning

confidence: 99%

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Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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Purpose With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy. Methods A systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020—assessing post-operative pain using analgesic, anaesthetic and surgical interventions—were identified from MEDLINE, EMBASE and Cochrane Databases. Results Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)—2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions—gabapentinoids and intrathecal opioid administration—although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence. Conclusion Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.

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Section: Discussionmentioning

confidence: 99%

“…Saini et al compared wound instillation with 20 ml of ropivacaine 0.25% to placebo [41]. Wound instillation was defined as the irrigation of the local analgesic into the surgical area for a dwell time of 60 s. Rescue analgesia included IV paracetamol and IV diclofenac.…”

Section: Locoregional Anaesthesiamentioning

confidence: 99%

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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Kommentar zu: Bilateraler Erector Spinae Plane Block bei lumbalen Fusionseingriffen

Rappert

2023

Die Wirbelsäule

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Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries – A prospective double-blinded randomised controlled trial

Pavithran¹,

Sudarshan²,

Eliyas³

et al. 2022

Indian Journal of Anaesthesia

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Background and Aims: Posterior lumbar spine fusion surgeries are associated with severe postoperative pain necessitating a multimodal analgesic regime. Wound infiltration with local anaesthetic is an accepted modality for postoperative analgesia in spine surgeries. Thoracolumbar interfascial plane (TLIP) block is a novel technique being evaluated for providing analgesia in lumbar spine surgeries. This study aimed to compare the analgesic efficacy of TLIP block compared to that of wound infiltration with local anaesthetic in terms of time to request the first dose of rescue analgesic. Methods: Seventy-one patients scheduled for posterior lumbar spine fusion under general anaesthesia were included in this double-blinded randomised controlled trial. Preoperatively, patients were randomly allocated to receive either a TLIP block (TLIP group) or wound infiltration (LI group). The primary endpoint was the time of the first request for rescue analgesia. Secondary endpoints were the total tramadol consumption and pain and comfort scores measured at various time points in the 48-h postoperative period. The trial was terminated after second interim analysis as the analgesic benefit of TLIP was evident both clinically and statistically. Results: The median (interquartile range) duration of the time of the first request for rescue analgesia was 1440 (1290, 2280) min in the TLIP group and 340 (180, 360) min in the infiltration group; P value <.001. The mean tramadol consumption was significantly higher in the infiltration group compared to the TLIP group, with a P value <.001. Conclusion: TLIP block provided better postoperative analgesia than that provided by wound infiltration with local anaesthetic.

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Study of wound instillation technique for effective postoperative analgesia using ropivacaine in lumbar spine surgery

Cited by 4 publications

References 17 publications

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Kommentar zu: Bilateraler Erector Spinae Plane Block bei lumbalen Fusionseingriffen

Comparison of thoracolumbar interfascial plane block with local anaesthetic infiltration in lumbar spine surgeries – A prospective double-blinded randomised controlled trial

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