Wound Infiltration and Instillation Technique for Postoperative Analgesia Using Bupivacaine in Patients Undergoing Lumbar Spine Surgeries

Abstract

Background: Pain relief after surgery continues to be a major medical challenge in clinical practice. Lumbar spine surgery is associated with significant postoperative pain. Providing optimal analgesia locally in the area of surgical wound, with little systemic side-effects, is a favourable option and has become an intrinsic part of multimodal analgesia. We aimed to assess and compare the effectiveness of local infiltration and instillation of bupivacaine for postoperative analgesia in patients undergoing lumbar spine surgery. Materials and methods: Forty-four adult patients of the American Society of Anesthesiologists (ASA) class I and II were randomly assigned into two groups, incorporating 22 patients per group. After the completion of lumbar spine surgery and after hemostasis was achieved, patients in group A received instillation of 20 ml of 0.25% bupivacaine at the surgical wound site and patients in group B received 20 ml of 0.25% bupivacaine infiltration into the paravertebral muscles on either side. Postoperative numerical rating scale (NRS) pain scores at 1, 2, 3, 4, 5, 6, 7, 8, 14, 20, and 24 hours; the time to first analgesic required, total rescue analgesic consumption, and adverse effects were recorded. Statistical analysis was done using IBM SPSS Statistics for Windows, Version 20.0 (Released 2011; IBM Corp, Armonk, New York, United States). Results: Time to the first analgesic requirement was significantly longer in group A (12.39±1.56 hours) compared to the B group (2.48±0.58 hours) (P < 0.001). The amount of rescue analgesia (diclofenac sodium) required was significantly higher in group B (135.00±46.17 milligrams) compared to A (93.75±33.32 milligrams) (P = 0.001). The number of analgesic demands was higher in the infiltration group compared to the instillation group and was observed to be statistically significant. Hemodynamic parameters remained comparable between the groups. Conclusion: Local instillation of surgical wound site provided better pain control than infiltration technique and is effective and safe postoperative analgesia in patients undergoing laminectomy surgeries.

RETRACTED: Effect of wound infiltration of dexmedetomidine in lumbar spine surgery on postoperative wound pain: A meta‐analysis

“…Nevertheless, a number of side effects, for example, nausea, vomiting and hypotension, have restricted the wide application of the product in clinical practice. Because operative pain is mainly caused by a surgical injury, local anaesthesia (LA) during the closing of the incision may be able to alleviate postoperative pain 8,9 . Adding auxiliary agents to LA may extend the postoperative relief of pain 10 .…”

“…Because operative pain is mainly caused by a surgical injury, local anaesthesia (LA) during the closing of the incision may be able to alleviate postoperative pain. 8 , 9 Adding auxiliary agents to LA may extend the postoperative relief of pain. 10 LA penetrates into the skin and under the skin causing the substance to diffuse, thereby blocking the pain.…”

Multimodal Analgesia

“…[41][42][43] Transversus abdominis plane blocks have also shown utility in anterior and lateral lumbar interbody fusion techniques. 44 Local anesthetic techniques, including infiltration of paravertebral muscles or instillation of the surgical wound site with bupivacaine, have shown benefit, with Kumar et al 45 reporting the greatest benefit with instillation technique. Instillation of bupivacaine was found superior to infiltration of the paravertebral musculature with significantly quicker time to supplemental analgesic requirement in the infiltration cohort who additionally required significantly higher amounts of rescue analgesia compared with the instillation cohort.…”

“…Local anesthetic techniques, including infiltration of paravertebral muscles or instillation of the surgical wound site with bupivacaine, have shown benefit, with Kumar et al45 reporting the greatest benefit with instillation technique. Instillation of bupivacaine was found superior to infiltration of the paravertebral musculature with significantly quicker time to supplemental analgesic requirement in the infiltration cohort who additionally required significantly higher amounts of rescue analgesia compared with the instillation cohort 45. Although adverse effects are rare, there is a significant risk of toxicity if inadvertently administered intravascularly during a regional nerve block 39…”

Multimodal Analgesia

“…Instillation of bupivacaine was found superior to infiltration of the paravertebral musculature with significantly quicker time to supplemental analgesic requirement in the infiltration cohort who additionally required significantly higher amounts of rescue analgesia compared with the instillation cohort. 45 Although adverse effects are rare, there is a significant risk of toxicity if inadvertently administered intravascularly during a regional nerve block. 39…”