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

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.