Postoperative analgesic effect of bupivacaine infiltration following lumbar disc surgery

Yıl 2019, Cilt: 5 Sayı: 5, 787 - 792, 04.09.2019

Tamer Tunçkale Numan Karaarslan Melek Tunçkale Tezcan Çalışkan

https://doi.org/10.18621/eurj.413635

Öz

Objectives:
Effectiveness of 0.5% bupivacaine administered onto
dura, under lumbar superficial fascia and subcutaneous tissue on postoperative
pain control was analyzed in patients undergoing lumbar microdiscectomy.

Methods: Sixty
adult patients scheduled to undergo elective, single-level lumbar discectomy
were randomly divided into four groups: the control group (Control), the subcutaneous tissue group
(Group C), which received 20 ml of 0.5% bupivacaine in the subcutaenous tissue,
the superficial fascia group (Group F), which received 12 ml bupivacaine in the
subcutaneous tissue and 8 ml in the space below the lumbar superficial fascia,
and the dura group (Group D), which received a total of 20 ml (100 mg) of
bupivacaine, consisting of 10 ml in the subcutaneous tissue, 8 ml in the space below
the lumbar superficial fascia, and 2 ml on the dura. Visual
Analog Scale Values (VAS) on postoperative 0, 15, 30, 45 minutes, at 1, 2, 4, 6,
12 and 24^th hour and time of the first analgesic need were evaluated
for all patients and recorded.

Results: While
mean VAS value measured at min 0 (as soon as the patient awakened) was 2.3 ± 1.2
in Group D; it was 2.7 ± 0.9 in Group C; 2.7 ± 1.0 in Group F and 3.1 ± 0.6 in
control group (p = 0.232). At the
end of 1^th hour, mean VAS value was recorded as 2.8 ± 1.0 in Group D; 3.6 ± 1.5 in Group C; 3.6 ± 1.1 in Group F and 4.4 ± 1.1 in control group (p = 0.005). In Group D, 0.5% bupivacaine
administered as 2, 8, 10 ml onto dura, fascia and subcutaneously was detected
to provide significantly lower VAS values and significantly longer first
analgesic need time.

Conclusions: 0.5% bupivacaine administered onto
dura, under lumbar superficial fascia and in subcutaneous tissue was detected
to be a simple, effective and safe method in lumbar microdiscectomy operations. 

Anahtar Kelimeler

lumbar microdisectomy, bupivacaine, pain, infiltration analgesia

Kaynakça

• [1] Apostolides PJ, Jocobowitz R, Sonntag VKH. Lumbar discectomy microdiscectomy: “the gold standard”. Clin Neurosurg 1995;43:228-38.
• [2] Erdine S. Postoperatif analjezi. In: Erdine S, ed. Ağrı sendromları ve tedavisi. 2nd ed., İstanbul: Gizben Maatbacılık, 2003;33-3.
• [3] Nagy I, Rice ASC. Applied physiogy of inflammatory pain. In: Rowbotham DJ, Macinteyre PE, eds. Clinical Pain Management: Acute Pain. London: Arnold Publishers, 2003:17-47.
• [4] Kantor TG. Physiology and treatment of pain and inflammation: analgesic effects of flurbiprofen. Am J Med 1986;80(Suppl 1);3-9.
• [5] Avtan L, Berber E, Avcı C. Laparoskopik cerrahide postoperatif analjezi. Ağrı Dergisi 1996;8:22-5.
• [6] Benumof JL. Management of postoperative pain. In: Benumof JL, ed. Anesthesia for Thoracic Surgery. 2nd ed.. Philedelphia, W.B: Sounders Company, 1995:756-74.
• [7] Mitchell RW, Smith G. The control of acute postoperative pain. Br J Anaesth 1989;63:147-58.
• [8] Schenk MR, Putzier M, Kügler B, Tohtz S, Voigt K, Schink T, et al. Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia. Anesth Analg 2006;103:1311-7.
• [9] Ersayli DT, Gurbet A, Bekar A, Uckunkaya N, Bilgin H. Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy. Spine 2006;31:2221-6.
• [10] Wright JE. Controlled trial of wound infiltration with bupivacaine for postoperative pain relief after apendicectomy in children. Br J Surg 1993;80:110-1.
• [11] Yaşar MA, Erdoğan M, Özmiş M, Akkuş MA, Erhan ÖL. Tiroid cerrahisinde uygulanan bupivakain infiltrasyonunun postoperatif analjezik etkinliği. Ağrı Dergisi 1994;9:35-37.
• [12] Leung CC, Chan YM, Ngai SW, Ng KF, Tsui SL. Effect of pre-incision skin infiltration on post-hysterectomy pain--a double-blind randomized controlled trial. Anaesth Intensive Care 2000;28:510-6.
• [13] Fozzard HA, Lee PJ, Lipkind GM. Mechanism of local anesthetic drug action on voltage-gated sodium channels. Curr Pharm Des 2005;11:2671-86.
• [14] Mirzai H, Tekin I, Alincak H. Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: a randomized controlled study. Spine 2002;27:343-6.
• [15] Kotil K, Tunckale T, Tatar Z, Koldas M, Kural A, Bilge T. Serum creatine phosphokinase activity and histological changes in the multifidus muscle: a prospective randomized controlled comparative study of discectomy with or without retraction. J Neurosurg Spine 2007;6:121-5.
• [16] Shin DA, Kim KN, Shin HC, Yoon DH. The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine 2008;8:39-43.
• [17] Jitpakdee T, Mandee S. Strategies for preventing side effects of systemic opioid in postoperative pediatric patients. Pediatr Anesth 2014;24:561-8.
• [18] Cherian MN, Mathews MP, Chandy MJ. Local wound infiltration with bupivacaine in lumbar laminectomy. Surg Neurol 1997;47:120-2; discussion 122-3.
• [19] Hernandez-Palazon J, Tortosa Serrano JA, Burguillos Lopez S, Molero Molero E. [Infiltration of the surgical wound with local anesthetic for postoperative analgesia in patients operated on for lumbar disc herniation. Comparative study of ropivacaine and bupivacaine]. Rev Esp Anestesiol Reanim 2001;48:17-20. [Article in Spanish]
• [20] Puffer RC, Tou K, Winkel RE, Bydon M, Currier B, Freedman BA. Liposomal bupivacain incisional injection in single-level lumbar spine surgery. Spine J 2016;16:1305-8.
• [21] Kim J, Burke SM, Kryzanski JT, Roberts RJ, Roguski M, Qu E, et al. The role of liposomal bupivacaine in reduction of postoperative pain after transforaminal lumbar interbody fusion: a clinical study. World Neurosurg 2016;91:460-7.