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Subject Area

Pain therapy

Document Type

Clinical Study

Abstract

Background Data: Patients scheduled for spinal surgeries are expected to experience severe postoperative pain. Thus, effective postoperative analgesia is necessary to obtain an enhanced functional outcome, early ambulation, short hospital stay and prevention of chronic pain. Although opioid is the key element of most postoperative analgesic regimens, multimodal therapy is currently an effective way to decrease opioid usage and the related adverse events. Pre-incision infiltration with local anesthetic is used to improve postoperative analgesia and reduce opioid consumption when given as a part of multimodal analgesia. Purpose: The purpose of this study was to prospectively evaluate the effectiveness of preemptive local infiltration with local anesthesia combined with systemic analgesia in pain control after spine surgery.Study Design: A prospective descriptive clinical case study. Patients and Methods: A prospective study of 147 cases of spine surgery operated at the neurosurgery department in Sohag university hospital from December 2011 to March 2015 was conducted. A basic monitoring was applied to all patients and anesthesia was induced according to the standardprotocol following preemptive local infiltration with local anesthesia. Postoperative pain was controlled with paracetamol, ketorolac and/or nalbuphine. Postoperative pain was assessed using visual analogue score (VAS).Results: The study included 66 females and 81 male patients, aged 19-77 years. Discectomy was rated in spine surgeries followed by lumbar fixation, laminectomy, spinal cord tumors, lateral mass fixation and discectomy with cage. VAS didn’t exceed score 3 except for 9 cases rating (6%). They requested rescue analgesia. Most of the patients were allowed to move 3 hours after surgery except for those who revealed intraoperative dural injury (11 cases). Almost all patients were discharged to home after a short hospital stay less than 3 days. Only 9 cases stayed >3 days. Conclusion: Preemptive local infiltration with local anesthesia combined with systemic analgesia allowed good pain control after spine surgery, early ambulation, shortened the time of hospital stay and decreased the incidence of complications. (2015ESJ098)

Keywords

Post spinal surgery, Pain, local infiltration, VAS

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