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Early Postoperative Analgesic Effects of a Single Epidural Injection of Ropivacaine Administered Preoperatively in Posterior Lumbar Interbody Spinal ArthrodesisA Pilot Randomized Controlled Trial
Hyun Kang, MD1; Ho Joong Jung, MD1; Jae Sung Lee, MD1; Jae Jun Yang, MD1; Hwa Yong Shin, MD1; Kwang-Sup Song, MD1
1 Departments of Orthopaedic Surgery (H.J.J., J.S.L., J.J.Y., and K.-S.S.) and Anesthesiology (H.K. and H.Y.S.), Chung-Ang University, College of Medicine, Heukseok-dong, Dongjak-gu, 224-1, Seoul, South Korea. E-mail address for H. Kang: roman00@freechal.com. E-mail address for H.J. Jung: sunu@cau.ac.kr. E-mail address for J.S. Lee: boneman@hanmail.net. E-mail address for J.J. Yang: jaejunyang@gmail.com. E-mail address for H.Y. Shin: pain@cau.ac.kr. E-mail address for K.-S. Song: ksong70@cau.ac.kr
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Investigation performed at the Departments of Orthopaedic Surgery and Anesthesiology, Chung-Ang University, College of Medicine, Seoul, South Korea

A commentary by Michael J. Bolesta, MD, is linked to the online version of this article at jbjs.org.



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Mar 06;95(5):393-399. doi: 10.2106/JBJS.K.01729
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Abstract

Background: 

Despite the suitable characteristics of ropivacaine as an epidural analgesic agent, such as better preservation of motor function and less neurotoxicity, we are aware of no data on its clinical application in pain management following lumbar spine surgery. The purpose of the present study was to evaluate the preemptive analgesic effects and safety of a single epidural injection of ropivacaine during lumbar arthrodesis.

Methods: 

We performed a randomized, double-blinded, intention-to-treat study. Patients with planned one-level posterior lumbar interbody arthrodesis were randomly assigned to either the injection group (n = 32) or the control group (n = 34). The injection group received a 10-mL epidural injection of 0.1% ropivacaine twenty minutes before the skin incision at the planned vertebral level, and the control group received an epidural injection of 10 mL of 0.9% saline solution. A numeric rating scale (from 0 to 10) was measured at seven time points after surgery (at two, four, eight, twelve, twenty-four, and forty-eight hours and at the time of discharge), and the frequency of pushed-button patient-controlled analgesia and total fentanyl consumption were assessed at similar time points (up to two, up to four, up to eight, up to twelve, up to twenty-four, and up to forty-eight hours after surgery). Postoperative nausea and vomiting, the duration of the hospital stay, and the Likert satisfaction score at the time of discharge were evaluated.

Results: 

There were no significant differences between the two groups preoperatively. The numeric rating scale score was higher until twelve hours (p < 0.05) and the frequency of button pushes was higher at every time point except eight to twelve hours (p < 0.05) in the control group as compared with the injection group. Fentanyl consumption until eight to twelve hours (p < 0.05) and total consumption (p < 0.001) at discharge were higher in the control group. There were no differences between the two groups in terms of postoperative nausea and vomiting, the duration of hospital stay, or the mean satisfaction score, and no transient motor weakness was seen in relation to epidural injection of ropivacaine.

Conclusions: 

A single-dose epidural injection of 0.1% ropivacaine before lumbar spine surgery is effective for reducing early postoperative pain without related complications such as transient motor weakness.

Level of Evidence: 

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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