Effect of continuous intra-incisional bupivacaine on postoperative pain in non-traumatic spinal fixation surgeries: a randomized controlled trial
Efeito da bupivacaína intra-incisional contínua na dor pós- -operatória em cirurgias não traumáticas de fixação da coluna vertebral: um estudo controlado randomizado
Sanaz Jowkar, Arash Farbood, Afshin Amini, Saman Asadi, Babak Pourabbas Tahvildari, Keyvan Eghbal, Naeimehossadat Asmarian, Vahid Parvin, Afshin Zare
Abstract
Background
Continuous injection of local anesthetics by using surgical wound catheters for postoperative pain relief has gained acceptance in recent years. However, whether this method can be alternatively used instead of systemic opioids in different surgical procedures has not yet been elucidated.
Objectives
The aim was to investigate the effect of continuous injection of bupivacaine through a catheter inside the surgical wound on reducing the postoperative pain of lumbar spine fusion surgeries.
Methods
In this clinical trial, 31 patients undergoing non-traumatic lumbar spine stabilization surgery were randomly assigned to receive (n = 15) or do not receive (n = 16) bupivacaine through a catheter inside the surgical wound, postoperatively. Pain intensity (NRS), dose of required morphine, and drug-related complications within 24 hours of intervention were assessed and compared by the Mann-Whitney and independent t-test.
Results
Mean pain intensity was significantly lower in the case group over the first postoperative hour in the recovery room (p < 0.001), which continued for the first 2 hours after entering the ward. The mean morphine intake was lower in the bupivacaine group during the first postoperative 24 hours (16 ± 0.88 vs. 7.33 ± 0.93 mg, p < 0.001). The two groups were not significantly different regarding drug-related complications.
Conclusion
Continuous intra-incisional infusion of bupivacaine helped better pain reduction during the early postoperative hours while sparing morphine consumption in the first postoperative day.
Keywords
Resumo
Justificativa: A injeção contínua de anestésicos locais usando cateteres de feridas cirúrgicas para alívio da dor pós-operatória ganhou aceitação nos últimos anos. No entanto, ainda não foi elucidado se esse método pode ser utilizado alternativamente aos opioides sistêmicos em diferentes procedimentos cirúrgicos. Objetivos: O objetivo foi investigar o efeito da injeção contínua de bupivacaína através de um cateter dentro da ferida operatória na redução da dor pós-operatória de cirurgias de artrodese da coluna lombar. Métodos: Neste ensaio clínico, 31 pacientes submetidos à cirurgia não traumática de estabilização da coluna lombar foram aleatoriamente designados para receber (n = 15) ou não receber (n = 16) bupivacaína por meio de um cateter dentro da ferida cirúrgica, no pós-operatório. A intensidade da dor (NRS), a dose de morfina necessária e as complicações relacionadas à droga dentro de 24 horas da intervenção foram avaliadas e comparadas pelo Mann-Whitney e teste t independente. Resultados: A intensidade média da dor foi significativamente menor no grupo caso durante a primeira hora de pós-operatório na sala de recuperação (p < 0,001), que continuou nas primeiras 2 horas após a entrada na enfermaria. A ingestão média de morfina foi menor no grupo bupivacaína durante as primeiras 24 horas de pós-operatório (16±0,88 vs 7,33±0,93 mg, p < 0,001). Os dois grupos não foram significativamente diferentes em relação às complicações relacionadas à droga. Conclusão: A infusão contínua intra-incisional de bupivacaína auxiliou na redução da dor nas primeiras horas de pós-operatório, poupando o consumo de morfina no primeiro dia de pós- -operatório.
Palavras-chave
References
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