A single-dose injection could be used for spine fusion pain management,
Single-dose epidural injections of
ropivacaine decreased postoperative pain scores when
administered preoperatively in patients undergoing lumbar
spine fusion, according to a presentation at the
2011 Annual Meeting of the North American Spine Society in
Our pre-emptive procedure could be used as [an] evidence-based and
spine surgery-specific analgesic protocol for multimodal treatments in lumbar
fusion surgery, study investigator Kwang-Sup Song, MD, PhD, of Seoul,
South Korea, said during his presentation.
Postoperative pain scores
In a prospective, randomized study, Song and colleagues injected 10 mL
ropivacaine approximately 20 minutes before surgery into 30 patients who
underwent lumbar spine fusion during a 2-year period. Excluded from the study
were patients weighing less than 45 kg or more than 100 kg, those with an
allergy to local anesthetics, severe underlying hepatic, renal or respiratory
diseases and patients with a history of psychiatric or opioid medication.
The goal of the study was to measure how the analgesic affected
postoperative pain against a control group with similar preoperative
demographic characteristics who did not receive the medication.
Single-dose epidural injection before lumbar surgery is simple and
ideal in a prone position, and there are no complications when using a
catheter, Song explained. He and colleagues also reported that they witnessed
no adverse effects of using ropivacaine in their study, such as motor weakness.
The highest pain scores were experienced at postoperative 2 hours,
[and] gradually diminished in both groups until 12 hours postoperatively,
according to Song. Investigators found significantly higher pain scores in the
control group vs. the ropivacaine group.
Patients in the study were permitted to self-administer fentanyl in
computer-controlled doses postoperatively and investigators injected 50
µg/mL rescue doses of fentanyl whenever Visual Analog Scale scores were
greater than 4 points. The frequency that patients used the fentanyl system to
relieve pain was higher in the control group at every time until
postoperative 48 hours, except between 8 hours and 12 hours
postoperatively and fentanyl consumption was also higher in the control group
until postoperative 12 hours, Song said.
Nausea and vomiting occurred less frequently in the ropivacaine group,
but he noted that this difference was not statistically significant.
When measuring C-reactive proteins (CRP), investigators found higher
CRPs in control patients at 72 postoperative hours. They noted that the
anti-inflammatory properties of ropivacaine may have contributed to this
phenomenon and further study is needed to investigate why CRP levels were
affected. by Jeff Craven
- Song KS, Yang JJ. Early postoperative analgesic effects of single
epidural ropivacaine injection before surgery in posterior lumbar spinal
fusion: A randomized clinical trial. Paper #80. Presented at the 2011 Annual
Meeting of the North American Spine Society. Nov. 2-5. Chicago.
- Kwang-Sup Song, MD, PhD, can be reached at the Department of
Orthopedic Surgery, Chung-Ang University College of Medicine, 84 Heukseok-Ro,
Dongjak-Gu, Seoul, Korea; +82 28 20 63 96; email:
- Disclosure: Song has no relevant financial disclosures.
This is an interesting study investigating the efficacy and safety of
single-dose epidural local anesthetic prior to lumbar spine fusion. While the
short-term results seem quite good based on the abstract, certainly further
study is necessary to evaluate the efficacy and any potential downside effects
at 36 hours, 48 hours and longer postoperatively (such as rebound pain and or
other negative effects short- or longer-term, as well as urinary retention and
narcotic requirements among others). With a push to shorten length of stays and
perform more procedures as outpatients and 23-hour stays, these kind anestetic
adjuncts become more exciting and intriguing.
Todd J. Albert, MD
Today Editorial Board member
Chairman of the Department of
President, The Rothman Institute
Disclosure: Albert has no relevant financial disclosures.