Wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia for transforaminal lumbar interbody fusion: a retrospective study

Abstract

Background: Surgical procedure usually causes serious postoperative pain and poor postoperative pain management negatively affects quality of life, function and recovery time. We aimed to investigate the role of wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia (PCA) in postoperative pain control for patients undergoing transforaminal lumbar interbody fusion.

Methods: One hundred twelve patients undergoing lumbar fusion were retrospectively reviewed and divided into two groups (ropivacaine and control groups) according to whether received wound infiltration with ropivacaine or not. Visual Analogue Scale (VAS) score, analgesics consumption, number of patients requiring rescue analgesic, hospital duration and incidence of complications were recorded. Surgical trauma was assessed using operation time, intraoperative blood loss and incision length.

Results: The amount of sufentanil consumption in ropivacaine group at 4 h postoperatively was lower than that of control group (24.5 ± 6.0 μg vs 32.1 ± 7.0 μg, P < 0.001) and similar results were observed at 8, 12, 24, 48 and 72 h postoperatively(P < 0.001). Fewer patients required rescue analgesia within 4 to 8 h postoperatively in ropivacaine group (10/60 vs 19/52, P = 0.017). Length of postoperative hospital durations were shorter in patients receiving ropivacaine infiltration compared to control cohorts (6.9 ± 0.9 days vs 7.4 ± 0.9 days, P = 0.015). The incidence of PONV in ropivacaine group was lower than that in control group (40.4% vs 18.3%, P = 0.01). However, VAS scores were similar in two groups at each follow-up points postoperatively, and no difference was observed(P > 0.05).

Conclusion: Wound infiltration with ropivacaine effectively reduces postoperative opioid consumption and PONV and may be a useful adjuvant to PCA to improve recovery for patients undergoing lumbar spine surgery.

Keywords: PCA; Pain management; Ropivacaine; Transforaminal lumbar interbody fusion; Wound infiltration.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

Boxplot showing sufentanil consumption in the postoperative period for two groups. The boxes indicate the interquartile range, the crosses within the boxes indicate the median, and the whiskers indicate the range. The asterisks indicate significance(P < 0.05). h = hours postoperatively

Fig. 2

Boxplot showing VAS scores for back pain over the first 72 h postoperatively for two groups. The boxes indicate the interquartile range, the crosses within the boxes indicate the median, and the whiskers indicate the range. No significant difference was observed at each time between two groups(P > 0.05). h = hours postoperatively