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Category: Volume 06 Issue 05 May 2018
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Title: Comparing the effects of Bupivacaine and Ropivacaine Instillation for Postoperative Analgesia in Patients Undergoing Lumbar Spine Surgery: A Prospective Randomised Double Blind Study

Authors: Manoj Kumar, Jay Brijesh S. Yadav, Dimple Saini

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.171

Abstract

Introduction: Laminectomy is associated with considerable postoperative pain. Providing analgesia locally in the area of surgical trauma, with minimal systemic side effects has become an integral part of multimodal analgesia. The objective of this study is to compare the effects of bupivacaine and ropivacaine instillation for postoperative analgesia in patients undergoing lumbar spine surgery.

Methods: The study was conducted in a double blind manner. 40 ASA I & II patients scheduled for lumbar laminectomy were randomly divided into two groups to receive either 20 ml (0.25%) of bupivacaine (group B) or ropivacaine (0.25%) instillation into the wound after securing hemostasis. After a dwell time of 60 sec the wound was closed in layers without mopping or suctioning. After extubation, the pain scores were evaluated by Numerical rating scale at 0 hours i.e., immediately after extubation and then at every 1 hour up to first 8 hours and then at every 6 hours till 24 hours and also the time for first demand of analgesia, number of analgesic demands and the total amount of analgesia consumed were noted by an independent observer.

Results: The area under curve for mean pain score over 24 hrs time period on the basis of NRS scale was 46.8±5.84 in ropivacaine group (R) and 44.78±5.36 in bupivacaine group (B) with p= 0.26. The duration of analgesia and number of demands and the amount of analgesia consumed was also found statistically not significant.

Conclusion: Surgical wound instillation with bupivacaine and ropivacaine provided better analgesic effect and safe postoperative analgesia in patients undergoing laminectomy surgeries.

References

  1. Cherian MN, Mathews MP, chandy MJ: Local wound infiltration with bupivacaine in lumbar laminectomy. Surg Neur; 47(2):120-2, 1997.
  2. DeVine J, Norvell DC, Ecker E, Fourney DR, Vaccaro A, Wang J, Andersson G (2011) Evaluating the correlation and responsiveness of patient-reported pain with function and quality-of-life outcomes after spine surgery. Spine (Phila Pa 1976) 36(21 Suppl): S69–S74. doi:10.1097/BRS.0b013e31822ef6de.
  3. Herroeder S, Pecher S, Schonherr ME, Kaulitz G, Hahnenkamp K, Friess H, Bottiger BW, Bauer H, Dijkgraaf OG, Durieux ME, Hollmann MW. Systemic lidocaine shortens length of hospital stay after colorectal surgery: a double-blinded, randomized, placebo-controlled trial. Ann Surg 2007; 246:192–200.
  4. Yokoyama M, Mizobuchi S, Nagano O, Fujii H, Yamashita M, Hirakawa M.The effects of epidural insertion site and surgical procedure on plasma lidocaine concentration. Anesthesia and Analgesia 2001; 92: 470–5.
  5. Jonnavithula N, Khandekia H,Durga P, Ramachandran G. Role of wound instillation with Bupivacaine for postoperative analgesia following lumbar laminectomy. M.E.J.Anaesth 2015; 23:193-98.
  6. Rushdi T, Kholeif A, Ibrahim M (2011) Ropivacaine 0.4% iontophoresis versus continuous catheter infusion after iliac crest bone grafting in lumbar spine surgery. Egypt J Anaesth 27:261–266.
  7. Hernández-Palazón J, Tortosa Serrano JA, Burguillos López S, Molero Molero E: Infiltration of the surgical wound with local anaesthetic for postoperative analgesia in patients operated on for lumbar disc herniation. Comparative study of ropivacaine and ,bupivacaine. Rev Esp Anestesiol Reanim; Jan, 48(1):17-20, 2001.
  8. Canan Kucuk, Nihal Kadiogullari, Ozgur Canoler, and Serpil Savl. A placebo-controlled comparison of bupivacaine and ropivacaine instillation for preventing postoperative pain after laparoscopic cholecystectomy. Surgery today. 2007;37(5):396-400.
  1. Cherian MN, Mathew MP, Chandy MJ. Local wound infiltration with bupivacaine in lumbar laminectomy. Surgical neurology, Feb , 47(2):120-2, 1997.
  2. MILLIGAN KR, MACAFEE AL, FOGARTY DJ, WALLACE RG, RAMSEY P: Intraoperative bupivacaine diminishes pain after lumbar discectomy. a randomised double-blind study. J Bone Joint Surg Br; 75(5):76971, 1993.
  3. Durga P, Jonnavithula N, Khandelia H, Ramachandran G. Role of wound instillation with bupivacaine through surgical drains for postoperative analgesia in modified radical mastectomy. Indian J Anaesth 2015;59:15-20.
  4. Margherita Bianconi et al. The Pharmacokinetics and Efficacy of Ropivacaine Continuous Wound Instillation After Spine Fusion Surgery. Anesth Analg 2004;98:166 –72.
  5. Neha T Das and Charulata Deshpande. Effects of Intraperitoneal Local Anaesthetics Bupivacaine and Ropivacaine versus Placebo on Postoperative Pain after Laparoscopic Cholecystectomy: A Randomised Double Blind Study. Journal of Clinical and Diagnostic Research. 2017 Jul, Vol-11(7): UC08-UC12.
  6. Andrei Goldstein et al. Preventing Postoperative Pain by Local Anesthetic Instillation After Laparoscopic Gyneco-logic Surgery: A Placebo-Controlled Comparison of Bupivacaine and Ropiva-caine. Anesth Analg 2000;91:403–7.
  7. Saurabh Agrawal, Srinivas Pai. Evaluation of postoperative pain relief with intra-peritoneal bupivacaine instillation in laparoscopic cholecystectomy-a randomized control study. Int Surg J. 2017 Apr;4(4):1195-1200.
  8. I. Yolanda-Prieto, A. L. Millán-Corrales, D. Palacios-Ríos, B. I. G arduño-Chávez, N. G. López-Cabrera, G. A. Millán-Cornejo, B. T. González-Rocha. Iniltration vs. instillation of ropivacaine 7.5% in radical mastectomies for postoperative analgesia. Medicina Universitaria 2014;16(62):15-18.

Corresponding Author

Jay Brijesh Singh Yadav

Department of Anaesthesiology, Uttar Pradesh University of Medical Sciences,

Saifai, Etawah, U.P. India

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