Because
local anesthetic continuous
wound instillation has not been evaluated after spine fusion surgery, we designed this study to determine whether this technique could enhance
analgesia and improve patient outcome after posterior lumbar
arthrodesis. Thirty-eight patients undergoing spine stabilization were randomly divided into two groups. The M group received a postoperative baseline IV infusion of
morphine plus
ketorolac for 24 h, and the R group received IV saline. In both groups, a multihole 16-gauge
catheter was placed subcutaneously; in the R group, the
wound was infiltrated with a
solution of
ropivacaine 0.5% 200 mg/40 mL, and infusion of
ropivacaine 0.2% 5 mL/h was maintained for 55 h. In the M group, saline infusion was given at the same rate.
Pain scores were taken at rest and on passive mobilization by nurses blinded to patient
analgesic treatment. The total plasma
ropivacaine concentration was evaluated.
Pain scores and rescue medication requirements (
diclofenac and
tramadol) were significantly less in the R group than in the M group.
Postoperative blood loss was less and the length of
hospital stay was shorter in the R group. The
ropivacaine peak total plasma concentration occurred at 24 h during infusion and was within safe limits; no toxic
local anesthetic side effects were observed. These results suggest that
wound infiltration and continuous instillation of
ropivacaine 0.2% is effective for
pain management after spine stabilization surgery.
IMPLICATIONS: