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Continuous wound infiltration of ropivacaine for reducing of postoperative pain after anterior lumbar fusion surgery: a clinical retrospective comparative study

  • Lee, Sang-Min (Department of Neurosurgery, Busan Wooridul Spine Hospital (WSH)) ;
  • Yun, Dong-Ju (Department of Neurosurgery, Busan Wooridul Spine Hospital (WSH)) ;
  • Lee, Sang-Ho (Department of Neurosurgery, Wooridul Spine Hospital (WSH) Cheongdam) ;
  • Lee, Hyung-Chang (Department of Cardiovascular Surgery, Busan Wooridul Spine Hospital (WSH)) ;
  • Joeng, Kyung Ho (Department of Neurosurgery, Busan Wooridul Spine Hospital (WSH))
  • Received : 2020.10.26
  • Accepted : 2020.12.14
  • Published : 2021.04.01

Abstract

Background: Local anesthetic infiltration at the site of a surgical wound is commonly used to control postoperative pain. In this study, we examined the effectiveness of continuous local infiltration at an abdominal surgical site in patients undergoing anterior lumbar interbody fusion (ALIF) surgery. Methods: Sixty-one patients who underwent ALIF surgery were enrolled. For thirtyone of them, a continuous local anesthetics infiltration system was used at the abdominal site. We collected data regarding the patients' sleep quality; satisfaction with pain control after surgery; abilities to perform physical tasks and the additional application of opioids in the postoperative 48 hours. Results: The On-Q system group showed reduced visual analogue scale scores for pain at the surgical site during rest and movement at 0, 12, 24, and 48 hours; and more was satisfied with pain control management at the first postoperative day (7.0 ± 1.2 vs. 6.0 ± 1.4; P = 0.003) and week (8.1 ± 1.6 vs. 7.0 ± 1.8; P = 0.010) than the control group. The number of additional patient-controlled analgesia (PCA) bolus and pethidine injections was lower in the On-Q group (PCA: 3.67 ± 1.35 vs. 4.60 ± 1.88; P = 0.049 and pethidine: 2.09 ± 1.07 vs. 2.73 ± 1.38; P = 0.032). Patients who used the On-Q system performed more diverse activity and achieved earlier ambulation than those in the control group. Conclusions: Continuous wound infiltration with ropivacaine using an On-Q system may be effective for controlling postoperative pain after ALIF surgery.

Keywords

References

  1. Ozyilmaz K, Ayoglu H, Okyay RD, Yurtlu S, Koksal B, Hanci V, et al. Postoperative analgesic effects of wound infiltration with tramadol and levobupivacaine in lumbar disk surgeries. J Neurosurg Anesthesiol 2012; 24: 331-5. https://doi.org/10.1097/ANA.0b013e3182611a1d
  2. Johansson B, Glise H, Hallerback B, Dalman P, Kristoffersson A. Preoperative local infiltration with ropivacaine for postoperative pain relief after cholecystectomy. Anesth Analg 1994; 78: 210-4. https://doi.org/10.1213/00000539-199402000-00003
  3. Kjaergaard M, Moiniche S, Olsen KS. Wound infiltration with local anesthetics for post-operative pain relief in lumbar spine surgery: a systematic review. Acta Anaesthesiol Scand 2012; 56: 282-90. https://doi.org/10.1111/j.1399-6576.2011.02629.x
  4. Perera AP, Chari A, Kostusiak M, Khan AA, Luoma AM, Casey ATH. Intramuscular local anesthetic infiltration at closure for postoperative analgesia in lumbar spine surgery: a systematic review and meta-analysis. Spine (Phila Pa 1976) 2017; 42: 1088-95. https://doi.org/10.1097/BRS.0000000000001443
  5. Phan K, Maharaj M, Assem Y, Mobbs RJ. Review of early clinical results and complications associated with oblique lumbar interbody fusion (OLIF). J Clin Neurosci 2016; 31: 23-9. https://doi.org/10.1016/j.jocn.2016.02.030
  6. Beaussier M, Parc Y, Guechot J, Cachanado M, Rousseau A, Lescot T; CATCH Study Investigators. Ropivacaine preperitoneal wound infusion for pain relief and prevention of incisional hyperalgesia after laparoscopic colorectal surgery: a randomized, triple-arm, double-blind controlled evaluation vs intravenous lidocaine infusion, the CATCH study. Colorectal Dis 2018; 20: 509-19. https://doi.org/10.1111/codi.14021
  7. Fassoulaki A, Vassi E, Korkolis D, Zotou M. Perioperative continuous ropivacaine wound infusion in laparoscopic cholecystectomy: a randomized controlled double-blind trial. Surg Laparosc Endosc Percutan Tech 2016; 26: 25-30. https://doi.org/10.1097/SLE.0000000000000224
  8. Mungroop TH, Veelo DP, Busch OR, van Dieren S, van Gulik TM, Karsten TM, et al. Continuous wound infiltration versus epidural analgesia after hepato-pancreato-biliary surgery (POP-UP): a randomised controlled, open-label, non-inferiority trial. Lancet Gastroenterol Hepatol 2016; 1: 105-13. https://doi.org/10.1016/s2468-1253(16)30012-7
  9. Reinikainen M, Syvaoja S, Hara K. Continuous wound infiltration with ropivacaine for analgesia after caesarean section: a randomised, placebo-controlled trial. Acta Anaesthesiol Scand 2014; 58: 973-9. https://doi.org/10.1111/aas.12362
  10. Mitra S, Purohit S, Sharma M. Postoperative analgesia after wound infiltration with tramadol and dexmedetomidine as an adjuvant to ropivacaine for lumbar discectomies: a randomized-controlled clinical trial. J Neurosurg Anesthesiol 2017; 29: 433-8. https://doi.org/10.1097/ANA.0000000000000422
  11. Hopf HW, Hunt TK, West JM, Blomquist P, Goodson WH 3rd, Jensen JA, et al. Wound tissue oxygen tension predicts the risk of wound infection in surgical patients. Arch Surg 1997; 132: 997-1004. https://doi.org/10.1001/archsurg.1997.01430330063010
  12. Woolf CJ, Chong MS. Preemptive analgesia--treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 1993; 77: 362-79. https://doi.org/10.1213/00000539-199308000-00026
  13. Knudsen K, Beckman Suurkula M, Blomberg S, Sjovall J, Edvardsson N. Central nervous and cardiovascular effects of i.v. infusions of ropivacaine, bupivacaine and placebo in volunteers. Br J Anaesth 1997; 78: 507-14. https://doi.org/10.1093/bja/78.5.507
  14. Ford GT, Guenter CA. Toward prevention of postoperative pulmonary complications. Am Rev Respir Dis 1984; 130: 4-5.
  15. Mullen JB, Cook WA Jr. Reduction of postoperative lumbar hemilaminectomy pain with Marcaine. Technical note. J Neurosurg 1979; 51: 126-7. https://doi.org/10.3171/jns.1979.51.1.0126
  16. Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg 2004; 98: 166-72.
  17. Xu B, Ren L, Tu W, Wu Z, Ai F, Zhou D, et al. Continuous wound infusion of ropivacaine for the control of pain after thoracolumbar spinal surgery: a randomized clinical trial. Eur Spine J 2017; 26: 825-31. https://doi.org/10.1007/s00586-015-3979-x
  18. Greze J, Vighetti A, Incagnoli P, Quesada JL, Albaladejo P, Palombi O, et al. Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. Eur Spine J 2017; 26: 832-9. https://doi.org/10.1007/s00586-016-4428-1
  19. Milligan KR, Macafee AL, Fogarty DJ, Wallace RG, Ramsey P. Intraoperative bupivacaine diminishes pain after lumbar discectomy. A randomised double-blind study. J Bone Joint Surg Br 1993; 75: 769-71.