Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

Abstract

This is a prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with levobupivacaine or levobupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. The objective of the study was to determine the efficacy of preemptive wound infiltration with levobupivacaine and levobupivacainemethylprednisolone at the surgical site for pain relief. Patients usually suffer significant pain after lumbar discectomy. Wound infiltration with local anesthetics with or without corticosteroids is one method to address this. A total of 100 patients were randomly allocated to five equal groups as follows: Group I had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group II had the same region infiltrated with 30 mL 0.25% levobupivacaine alone before closure; Group III had this region infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV this region was infiltrated with 30 mL 0.25% levobupivacaine alone before incision; and in Group C (controls) this region was infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores and morphine usage were recorded. All four treatment groups showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of levobupivacaine or levobupivacaine-methylprednisolone into the muscle near the operative site provides more effective analgesia after lumbar discectomy. Our data suggest that preemptive infiltration of the wound site with levobupivacaine alone or combined with methylprednisolone provides effective pain control with reduced opiate dose after unilateral lumbar discectomy.

The Comparison of the Effects of Different Doses of Levobupivacaine Infiltration on Wound Healing

“…Matsota et al did not report any case of myotoxicity in their study while evaluating the postoperative analgesia after wound infiltration with levobupivacaine in children undergoing inguinal hernia operation [22]. Another study by Gurbet et al supports these data where they have not encountered any case of myotoxicity with levobupivacaine infiltration on adult patients undergoing laminectomy [23]. In our study, we did not encounter any hint of macroscopic sign of myotoxicity while the tissue samples were being collected and can say that we did not observe a myotoxic effect of levobupivacaine but believe that more prospective studies are needed.…”

The Effects of Preincisional Levobupivacaine Infiltration on Extubation Comfort, Postoperative Recovery and Visual Analogue Scale in Appendectomy Patients

“…This difference continued for 24 hours. Gurbet et al (14) evaluated the effect of pre-emptive analgesia on unilateral lumbar discectomy patients. They classified all patients into five groups: 30 mL of 0.25% levobupivacaine and 40 mg of methylprednisolone administered just before the sutures of inscision to Group 1 patients, Group 2 patients treated with only levobupivacaine ipsilateral intramuscularly Group 3 and 4 patients were also treated in the same way as Group 2 patients but with levobupivacaine administered before incision.…”

Preoperative and Postoperative Anesthetic and Analgesic Techniques for Minimally Invasive Surgery of the Spine

“…Further, the deeper tissues should be infiltrated with bupivacaine 0.25%, ropivacaine 0.2% (safer in terms of cardiotoxicity) or levobupivacaine 40 to 50 mL at the time of tissue dissection before commencing the surgery on the spine for the pathology. 47 After the surgical procedure has been completed liberal use should be made of long-acting local anesthetics, taking care that the drug does not spread to the nerve roots (as it may obscure neurologic assessments made during the immediate postoperative period). However, there are reports of infiltration of bupivacaine 0.5%, 2 mL onto the nerve root sheath (at the level of disc surgery) before disc surgery, resulting in decreased postoperative analgesic requirement.…”