Dexamethasone as Adjuvant to Ropivacaine in Wound Infiltration for Postoperative Analgesia Following Spinal Surgery: A Randomized, Double-Blinded, Controlled Trial

Abstract

Orignial ArticleBACKGROUND: Pain following spinal surgery can limit early mobility and increase the risk of chronic pain. Intraoperative wound infiltration by local anesthetics for postoperative analgesia has been widely performed.OBJETIVE: This study aims to assess the analgesic effects of dexamethasone as an adjuvant to ropivacaine in wound infiltration after lumbar surgery. PATIENTS AND METHODS:In this study, we randomly assigned sixty patients undergoing lumbar laminectomy and/ or osteosynthesis into two groups of 30 patients each. The control group (r-group) received only Ropivacaine in the wound infiltration, while the intervention group (RD-group) received ropivacaine with the addition of dexamethasone .Both groups were administered patient-controlled analgesia (PCA) with morphine for self-medication. RESULTS:Postoperatively, a blinded evaluator assessed pain at hour 0 (H0), recorded the assessment of surgical wound pain using the visual analog scale (VAS) at 4, 6, 12, 24, and 48 hours, as well as the time to the first opioid request, cumulative morphine consumption, opioid-related side effects, and length of stay. The RD-group had significantly lower VAS scores for postoperative pain within 24 hours compared to the R-group (P<0.005). However, no significant difference was observed between the two groups for pain reported at 48 hours. The RD-group exhibited significantly lower opioid requirements within the first 48 hours (P<0.001) and a significantly longer time to first analgesic demand of PCA compared to the control group (P<0.05). CONCLUSION:Our study suggests that the addition of dexamethasone to ropivacaine in wound infiltration for patients undergoing lumbar laminectomy and/or osteosynthesis can lead to a reduction in morphine consumption, improved analgesia, and a shorter length of hospitalization.