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Related Concept Videos

Local Anesthetics: Clinical Application as Spinal Anesthesia01:11

Local Anesthetics: Clinical Application as Spinal Anesthesia

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Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...
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Related Experiment Video

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Local wound anesthesia in spine surgery-a randomized, double-blind, controlled trial.

Samuel Haupt1, Christoph Johannes Laux1, Steven Mark Maurer1

  • 1University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland.

The Spine Journal : Official Journal of the North American Spine Society
|April 15, 2026
PubMed
Summary

Local wound infiltration with ropivacaine or levobupivacaine/tramadol is safe but offers no significant pain relief or opioid reduction after lumbar spine surgery. Enhanced multimodal strategies are needed for better recovery.

Keywords:
LevobupivacaineLocal wound infiltrationLumbar spine surgeryMultimodal analgesiaOpioid consumptionPostoperative painRandomized controlled trialRopivacaine

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Area of Science:

  • Anesthesiology
  • Orthopedic Surgery
  • Pain Management

Background:

  • Effective postoperative pain management is crucial in spine surgery.
  • Local wound infiltration is a component of multimodal analgesia, but comparative data are limited.
  • This study addresses the need for high-quality comparative data on different local anesthetic infiltration regimens.

Purpose of the Study:

  • To evaluate the analgesic efficacy and safety of ropivacaine and levobupivacaine/tramadol wound infiltration compared to placebo.
  • The study aimed to assess pain intensity, opioid consumption, and recovery metrics post-lumbar spine surgery.

Main Methods:

  • Prospective, randomized, double-blind, controlled clinical trial involving 125 patients undergoing lumbar spine surgery.
  • Patients received intraoperative wound infiltration with saline (placebo), 0.75% ropivacaine, or 0.5% levobupivacaine + 100 mg tramadol.
  • Outcomes included postoperative pain (VAS), opioid consumption, hospital stay, sick leave, and adverse events.

Main Results:

  • No significant differences in postoperative pain scores or opioid consumption were observed between groups.
  • Hospital stay and functional recovery were comparable across all treatment arms.
  • Ropivacaine group showed a shorter sick leave duration compared to placebo (p=0.021); no adverse events related to infiltration occurred.

Conclusions:

  • Local wound infiltration with ropivacaine or levobupivacaine/tramadol is safe but not clinically beneficial for early pain control or opioid reduction in lumbar spine surgery.
  • The findings suggest that current local infiltration methods may not be sufficient for optimal postoperative recovery.
  • Broader multimodal analgesic strategies are likely necessary to improve patient outcomes after lumbar spine surgery.