Wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia for transforaminal lumbar interbody fusion: a retrospective study

Abstract

Background Surgical procedure usually causes serious postoperative pain and poor postoperative pain management negatively affects quality of life, function and recovery time. We aimed to investigate the role of wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia (PCA) in postoperative pain control for patients undergoing transforaminal lumbar interbody fusion. Methods One hundred twelve patients undergoing lumbar fusion were retrospectively reviewed and divided into two groups (ropivacaine and control groups) according to whether received wound infiltration with ropivacaine or not. Visual Analogue Scale (VAS) score, analgesics consumption, number of patients requiring rescue analgesic, hospital duration and incidence of complications were recorded. Surgical trauma was assessed using operation time, intraoperative blood loss and incision length. Results The amount of sufentanil consumption in ropivacaine group at 4 h postoperatively was lower than that of control group (24.5 ± 6.0 μg vs 32.1 ± 7.0 μg, P < 0.001) and similar results were observed at 8, 12, 24, 48 and 72 h postoperatively(P < 0.001). Fewer patients required rescue analgesia within 4 to 8 h postoperatively in ropivacaine group (10/60 vs 19/52, P = 0.017). Length of postoperative hospital durations were shorter in patients receiving ropivacaine infiltration compared to control cohorts (6.9 ± 0.9 days vs 7.4 ± 0.9 days, P = 0.015). The incidence of PONV in ropivacaine group was lower than that in control group (40.4% vs 18.3%, P = 0.01). However, VAS scores were similar in two groups at each follow-up points postoperatively, and no difference was observed(P > 0.05). Conclusion Wound infiltration with ropivacaine effectively reduces postoperative opioid consumption and PONV and may be a useful adjuvant to PCA to improve recovery for patients undergoing lumbar spine surgery.

Bilateral lumbar Ultrasound-guided Erector Spinae Plane Block versus Local Anaesthetic Infiltration for Perioperative Analgesia in Lumbar Spine Surgery: A Randomized Controlled Trial

“…More recently, pathways of care for spine surgery which emphasize opioid-sparing LA-based regional techniques have been described [1,10,11]. There is growing interest in peripheral pain control by incisional local anesthesia: wound infusion with LA can block the peripheral nerve endings and attenuate pain [1,7,8,12,13]. Several studies showed that continuous wound infusion seems to guarantee better pain control than intravenous opioids injection, but the patients needed to be inserted with catheters connected to the infusion pump within the wounds, raising the risk of impaired wound healing and local infection [12,13].…”

“…There is growing interest in peripheral pain control by incisional local anesthesia: wound infusion with LA can block the peripheral nerve endings and attenuate pain [1,7,8,12,13]. Several studies showed that continuous wound infusion seems to guarantee better pain control than intravenous opioids injection, but the patients needed to be inserted with catheters connected to the infusion pump within the wounds, raising the risk of impaired wound healing and local infection [12,13]. Kraiwattanapong et al suggested that intraoperative wound in ltration with multimodal drugs (an opioid, a NSAID, a long-acting LA, and epinephrine) reduced postoperative morphine consumption and decreased pain score after spine surgery; however, a systemic effect of drugs administered into the tissues cannot be excluded [22].…”

“…The recent work from the PROSPECT groups tried to identify the analgesic regimen for optimal pain management after spine surgery, recommending multimodal pain management [7][8][9]. More recently, pathways of care for spine surgery which emphasize opioid-sparing local anesthetic-based regional techniques have been described [1,7,8,[10][11][12][13]]. A regional technique suitable for spine surgery should cover the innervation of the relevant vertebrae and paravertebral muscles and include the dorsal roots of the spinal nerves at the level of surgery [14].…”

Bilateral lumbar ultrasound-guided erector spinae plane block versus local anesthetic infiltration for perioperative analgesia in lumbar spine surgery: a randomized controlled trial

“…The recent work from the PROSPECT groups tried to identify the analgesic regimen for optimal pain management after spine surgery, recommending multimodal pain management [7][8][9]. More recently, pathways of care for spine surgery which emphasize opioid-sparing local anesthetic-based regional techniques have been described [1,7,8,[10][11][12][13]. A regional technique suitable for spine surgery should cover the innervation of the relevant vertebrae and paravertebral muscles and include the dorsal roots of the spinal nerves at the level of surgery [14].…”

“…A regional technique suitable for spine surgery should cover the innervation of the relevant vertebrae and paravertebral muscles and include the dorsal roots of the spinal nerves at the level of surgery [14]. Wound infusion with local anesthetic (LA) agents can attenuate pain blocking peripheral nerve endings for several hours after operation [12,13]. Erector spinae plane block (ESPB) is a novel regional anesthesia technique in which LA are injected into the plane between the fascia of the erector spinae muscle and the vertebral transverse process, involving the dorsal rami of spinal nerves, and is safe and easy to perform under ultrasound (US) guidance [15,16].…”