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

Buvanendran, Asokumar; Thillainathan, Vijay

doi:10.1097/brs.0b013e31820240f8

Cited by 41 publications

(16 citation statements)

References 56 publications

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“…This includes multilevel instrumentation which is often associated with severe pain and consumption of large amounts of opioids thereby hindering postoperative mobilization and rehabilitation [3,4]. Also, patients undergoing major spine surgery often suffer from pre-operative chronic pain, further challenging postoperative pain treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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“…Despite the ongoing characterization of these cells from a functional perspective, few have addressed the influence that adjuvants to the respective therapy might have on hMSC integrity. Among the more commonly used adjuvant compounds in orthopedic practices are anesthetics, which are used to minimize patient sensitivity and discomfort [13,14] and have been well characterized in the native joint niche with respect to cartilage.…”

Section: Introductionmentioning

confidence: 99%

“…Although many groups have demonstrated LA-induced chondrocyte toxicity and the coinciding upregulation of cartilagedegradation factors [16], little work has been performed with LAs with regard to hMSCs, which hold promise for repairing various tissues of orthopedic interest including cartilage [9]. In orthopedic injuries, the delivery of hMSCs is often required intra-articularly and at regions surrounding damaged ligament or tendon (e.g., anterior cruciate ligament), where it is common to introduce LAs before, during, and after a procedure [13,14]. Because of this practice, it is of critical importance to gain a working knowledge of the risks associated with the use of LAs in combination with hMSCs and to recognize the implications it may have for clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Amide-Type Local Anesthetics and Human Mesenchymal Stem Cells: Clinical Implications for Stem Cell Therapy

Dregalla

Lyons

Reischling

et al. 2014

Stem Cells Translational Medicine

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In the realm of regenerative medicine, human mesenchymal stem cells (hMSCs) are gaining attention as a cell source for the repair and regeneration of tissues spanning an array of medical disciplines. In orthopedics, hMSCs are often delivered in a site-specific manner at the area of interest and may require the concurrent application of local anesthetics (LAs). To address the implications of using hMSCs in combination with anesthetics for intra-articular applications, we investigated the effect that clinically relevant doses of amide-type LAs have on the viability of bone marrow-derived hMSCs and began to characterize the mechanism of LA-induced hMSC death. In our study, culture-expanded hMSCs from three donors were exposed to the amide-type LAs ropivacaine, lidocaine, bupivacaine, and mepivacaine. To replicate the physiological dilution of LAs once injected into the synovial capsule, each anesthetic was reduced to 12.5%, 25%, and 50% of the stock solution and incubated with each hMSC line for 40 minutes, 120 minutes, 360 minutes, and 24 hours. At each time point, cell viability assays were performed. We found that extended treatment with LAs for 24 hours had a significant impact on both hMSC viability and adhesion. In addition, hMSC treatment with three of the four anesthetics resulted in cell death via apoptosis following brief exposures. Ultimately, we concluded that amide-type LAs induce hMSC apoptosis in a time- and dose-dependent manner that may threaten clinical outcomes, following a similar trend that has been established between these particular anesthetics and articular chondrocytes both in vitro and in vivo.

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“…Injected local anesthetics are commonly applied for both diagnostic and therapeutic purposes in perioperative and ambulatory settings in orthopedic practices and for the treatment of musculoskeletal pain . They are commonly administered periprocedurally along with MSCs in regions surrounding damaged ligament or tendon . Lidocaine is one of the most commonly used local anesthetics due to its rapid onset of action, safety profile, low cost, and wide availability .…”

Section: Introductionmentioning

confidence: 99%

“…36 They are commonly administered periprocedurally along with MSCs in regions surrounding damaged ligament or tendon. 37,38 Lidocaine is one of the most commonly used local anesthetics due to its rapid onset of action, safety profile, low cost, and wide availability. [39][40][41] Like other anesthetics in its class, lidocaine is known to inhibit sodium voltage-dependent channels in nerve cells, 42 thus preventing nerve signal conduction and thereby reducing pain.…”

Section: Introductionmentioning

confidence: 99%

Effect of Lidocaine on Viability and Gene Expression of Human Adipose–derived Mesenchymal Stem Cells: An in vitro Study

Nie

Kubrova

et al. 2019

PM&R

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Objective To assess the biologic effects of lidocaine on the viability, proliferation, and function of human adipose tissue–derived mesenchymal stromal/stem cells (MSCs) in vitro. Methods Adipose‐derived MSCs from three donors were exposed to lidocaine at various dilutions (2 mg/mL to 8 mg/mL) and exposure times (0.5 to 4 hours). Cell number and viability, mitochondrial activity, and real‐time reverse‐transcriptase quantitative polymerase chain reaction (RT‐qPCR) were analyzed at 0 (immediate effects) or 24 and 48 hours (recovery effects) after treatment with lidocaine. Results Trypan blue staining showed that increasing concentrations of lidocaine decreased the number of observable viable cells. 3‐[4,5,dimethylthiazol‐2‐yl]‐5‐[3‐carboxymethoxy‐phenyl]‐2‐[4‐sulfophenyl]‐2H‐tetrazolium (MTS) assays revealed a concentration‐ and time‐ dependent decline of mitochondrial activity and proliferative ability. Gene expression analysis by RT‐qPCR revealed that adipose‐derived MSCs exposed to lidocaine express robust levels of stress response/cytoprotective genes. However, higher concentrations of lidocaine caused a significant downregulation of these genes. No significant differences were observed in expression of extracellular matrix (ECM) markers COL1A1 and DCN except for COL3A1 (P < .05). Levels of messenger RNA (mRNA) for proliferation markers (CCNB2, HIST2H4A, P < .001) and MKI67 (P < .001) increased at 24 and 48 hours. Expression levels of several transcription factors— including SP1, PRRX1, and ATF1—were modulated in the same manner. MSC surface markers CD44 and CD105 demonstrated decreased expression immediately after treatment, but at 24 and 48 hours postexposure, the MSC markers showed no significant difference among groups. Conclusion Lidocaine is toxic to MSCs in a dose‐ and time‐ dependent manner. MSC exposure to high (4‐8 mg/mL) concentrations of lidocaine for prolonged periods can affect their biologic functions. Although the exposure time in vivo is short, it is essential to choose safe concentrations when applying lidocaine along with MSCs to avoid compromising the viability and potency of the stem cell therapy.

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

Cited by 41 publications

References 56 publications

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

Amide-Type Local Anesthetics and Human Mesenchymal Stem Cells: Clinical Implications for Stem Cell Therapy

Effect of Lidocaine on Viability and Gene Expression of Human Adipose–derived Mesenchymal Stem Cells: An in vitro Study

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