Preemptive Segmental Epidural Levobupivacaine Administration and Wound Infiltration Following Posterior Fusion Surgery: A Case Serie

Abstract

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : The current study aimed to provide intraoperative smooth wake-up test and postoperative effective analgesia by segmental epidural analgesia and wound infiltration in patients undergoing posterior fusion surgery. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Fifteen ASA I-II adolescent patients aged 11-16 undergoing posterior fusion and instrumentation were included to the study. After general anesthesia with standard intravenous anesthesia, epidural catheter was inserted to all patients in lateral decubitus position. Following confirmation of the place of the catheter under scopy, initially 3-4 ml of prepared mixture was administered from the catheter and then the catheter was retracted and during retraction, 1-2 mL of the mixture was given to each segment. Neuromonitorization was achieved with motor evoked potential (MEP). Postoperative pain was evaluated with visual analogue scale (VAS). Paracetamol infusion and nonsteroidal antiinflammatory analgesics were given for routine postoperative pain management. Intravenous patient-controlled analgesia with morphine was prepared to be given in case of VAS score higher than 40. R Re es su ul lt ts s: : In all patients effective analgesia was achieved for postoperative 24 hours. No side effects and hemodynamic impairment were observed. The highest pain scores were obtained at the postoperative 12 th hour and during movement. There was no requirement for morphine patient controlled anesthesia (PCA) as VAS values were lower than 40. The sleep quality of patients and the patient satisfaction were very good in all patients. C Co on nc cl lu us si io on n: : Segmental epidural analgesia with a preoperatively placed epidural catheter and wound infiltration is a simple and reliable method for effective pain control in posterior fusion and instrumentation surgery in patients with adolescent idiopathic scoliosis. K Ke ey y W Wo or rd ds s: : Levobupivacaine; analgesia, epidural; scoliosis; anesthesia, local Ö ÖZ ZE ET T A Am ma aç ç: : Çalışmanın amacı, posterior füzyon cerrahisi uygulanan hastalarda preemptif segmental epidural analjezi ve yara yeri infiltrasyonu ile intraoperatif yumuşak wake-up testi ve etkin postoperatif analjezi sağlamaktır. G Ge er re eç ç v ve e Y Yö ön nt te em ml le er r: : Posterior füzyon ve enstrümentasyon uygulanacak 15 ASA I-II adolesan hasta (11-16 yaş aralığında) çalışmaya dâhil edildi. Standart intravenöz anesteziklerle genel anestezi uygulanmasının ardından tüm hastalara lateral dekübit pozisyonda epidural kateter yerleştirildi. Skopi altında kateter yerinin doğrulanmasını takiben hazırlanan karışımdan ilk olarak 3-4 ml verildi ve daha sonra kateter çekilerek her segmente 1-2 ml verildi. Nöromonitörizas-yon motor uyarılmış potansiyel (MEP) ile sağlandı. Postoperatif ağrı, visual analog skalası (VAS) ile değerlendirildi. Rutin ağrı tedavisi için parasetamol infüzyon ve nonsteroid-antiinflamatuar ilaçlar verildi. VAS skoru 40'ın üzerinde olması durumunda morfin ile intravenöz...

Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

“…CWI with local anesthetics via catheters placed in the surgical wound before closure prevents nociceptive impulses, relieves postoperative pain, 62 and can have significant opioid sparing effect. 60 A recent retrospective chart review of 81 patients found that in addition to IV PCA and oral opioids, CWI bupivacaine provided via elastomeric pumps was associated with clinically and statistically significant improvements in postoperative course, and that the addition of multimodal pain management with gabapentin and methocarbamol was associated with trends toward JPOSNA Volume 3, Number 3, August 2021…”

“…63 An earlier randomized, prospective, double blinded study with 30 participants investigating the use of CWI and epidural anesthesia in addition to IV PCA concluded that this combination was an "effective and simple method" for postoperative analgesia with significant reductions in postoperative morphine consumption and VAS pain scores versus a control group receiving IV PCA alone. 62 A retrospective chart review of 107 patients in 2011 found that compared to narcotic and non-narcotic PCA, postoperative wound irrigation with 0.1-0.2% ropivacaine in combination with NSAIDs was more effective in that it provided for earlier feeding and reduced incidence of vomiting. 23…”