The effects of pre-emptive analgesia with bupivacaine on acute post-laminectomy pain

Mordeniz, Cengiz; Torun, Fuat; Soran, Ahmet Faruk; Beyazoglu, Orhan; Karabağ, Hamza; Çakır, Ahmet; Yücetaş, Şeyho Cem

doi:10.1007/s00402-009-0961-2

Cited by 13 publications

(6 citation statements)

References 21 publications

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“…Mordeniz et al evaluated the analgesic effects of a perineural infiltration with 2 ml of bupivacaine 0.5% [39]. Perineural infiltration was defined as the infiltration of local anaesthetics in the irritated neural root sheath, before root extraction.…”

Section: Locoregional Anaesthesiamentioning

confidence: 99%

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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Purpose With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy. Methods A systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020—assessing post-operative pain using analgesic, anaesthetic and surgical interventions—were identified from MEDLINE, EMBASE and Cochrane Databases. Results Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)—2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions—gabapentinoids and intrathecal opioid administration—although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence. Conclusion Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.

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Section: Locoregional Anaesthesiamentioning

confidence: 99%

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

et al. 2020

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“…In spine surgery, the deep neural blocks are already applied using neuraxial,[ 30 ] and the neural sheath block which is promising, as 41% of patients required no analgesia till discharge. [ 31 ] However, surgical exposure is required, so it may be suitable for discectomy. Likewise, the epidural and intrathecal administration are effective for analgesia in scoliosis surgery,[ 30 ] but the evidence mostly limits its implication to postoperative analgesia, Practically, there is a high rate of epidural failure.…”

Section: Discussionmentioning

confidence: 99%

High-volume, multilevel local anesthetics–Epinephrine infiltration in kyphoscoliosis surgery

Mazy

Serry

Kassem

2021

Journal of Anaesthesiology Clinical Pharmacology

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Background and Aims: Local anesthetic (LA) infiltration is one of the analgesic techniques employed during scoliosis correction surgery. However, its efficacy is controversial. In the present study for optimizing analgesia using the infiltration technique, we proposed two modifications; first is the preemptive use of high volume infiltration, second is applying three anatomical multilevel infiltrations involving the sensory, motor, and sympathetic innervations consecutively. Material and Methods: This prospective study involved 48 patients randomized into two groups. After general anesthesia (GA), the infiltration group (I) received bupivacaine 0.5% 2 mg/kg, lidocaine 5 mg/kg, and epinephrine 5 mcg/mL of the total volume (100 mL per 10 cm of the wound length) as a preemptive infiltration at three levels; subcutaneous, intramuscular, and the deep neural paravertebral levels, timed before skin incision, muscular dissection, and instrumentation consecutively. The control group (C) received normal saline in the same manner. Data were compared by Mann-Whitney, Chi-square, and t -test as suitable. Results: Intraoperatively, the LA infiltration reduced fentanyl, atracurium, isoflurane, nitroglycerine, and propofol consumption. Postoperatively, there was a 41% reduction in morphine consumption, longer time to the first analgesic request, lower VAS, early ambulation, and hospital discharge with high-patient satisfaction. Conclusion: The preemptive, high-volume, multilevel infiltration provided a significant intra and postoperative analgesia in scoliosis surgery.

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“…Unfortunately most reports described local instillation after incision [54,[91][92][93][94] immediately after exposure of the affected nerve root or the more superficial layers before closure, all of which, despite some authors have suggested [91,92], cannot be considered as 'preemptive' but rather 'preventive'.…”

Section: Peripheral Blocks and Local Infiltration Techniquesmentioning

confidence: 99%

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

N-M¹,

Mb²,

Sermeus³

et al. 2015

J Spine

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The use of regional analgesia techniques for postoperative analgesia in spine surgery is less frequently used in comparison with conventional oral and parenteral treatment. This may be explained by the fact that surgery is mostly performed under general anesthesia. Although objections of the surgeon are comprehensible, there is a growing number of studies using regional techniques for the treatment of pain after this surgery.When postoperative analgesia is the focus then regional techniques can be initiated at any time-point of the procedure while all ages and types of surgery, even extensive scoliosis fusion may benefit from it. The present overview will focus on the feasibility of (loco)regional techniques to be used for postoperative analgesia, medications used alone or in combination, as a single bolus or through persistent catheters and with special attention to pain relief following scoliosis repair.In general neuraxial techniques offer lower pain scores and/or less need for opioid rescue in comparison with systemic conventional analgesia although much less benefit may be noticed in patients operated for spinal fusion than for disc surgery, laminectomy and adolescent scoliosis correction. The actual literature provides little evidence with respect to the best timing of initiation, the best route nor the best dose in relationship to the type of surgery. Besides neuraxial techniques several alternatives have found their way in this type of intervention. As all techniques described offered variable success rates, future research is mandatory to determine their superiority over general anesthesia and conventional pain therapy modalities.

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The effects of pre-emptive analgesia with bupivacaine on acute post-laminectomy pain

Abstract: Our data suggests that pre-emptive analgesia via perineural infiltration of bupivacaine is a simple, and effective method for post-operative acute pain relief.

Cited by 13 publications

References 21 publications

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

High-volume, multilevel local anesthetics–Epinephrine infiltration in kyphoscoliosis surgery

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

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