Effect of Intraoperative epidural levobupivacaine administration in lumbar disc surgery for postoperative pain
Abstract views: 173 / PDF downloads: 73
Keywords:Diskectomy, Neurosurgery, Local Anesthesia
Aim: Postoperative pain is an essential problem that affects morbidity in surgical cases. We aimed to provide maximal benefits with minimal side effects, facilitate the recovery period, accelerate mobilization, and provide patient safety and comfort through the usage of the drug and method of our choice to provide postoperative analgesia.
Material and Method: Our study included 60 elective or urgent lumbar disc surgery cases. The patients were randomly divided into two groups; (a) The Group S; patients receiving general anesthesia and intraoperative epidural saline injection, and (b) The Group L; patients receiving general anesthesia and intraoperative epidural 2.5 mg/mL levobupivacaine 10 mL injection. The patient’s hemodynamic parameters were monitored perioperatively. To all patients, in case of necessity, patient-controlled analgesia with IV morphine was administered. The pain assessment was done using a numeric pain rating scale and visual analog scale. In addition, morphine usage during the 24 hours, pain scores, mobilization time, patient satisfaction, and side effects were evaluated.
Results: In the levobupivacaine group, the pain scores were lower during the whole trial, the morphine consumption in the 24 hour period was lower, the first time of mobilization was shorter, the patient satisfaction was more remarkable, and this group was more clinically significant considering side effects.
Conclusion: The usage of epidural bupivacaine combined with IV morphine instead of IV morphine alone for postoperative analgesia is more beneficial for early mobilization, reducing complications, and better patient satisfaction
Özyalçın SN, Erdine S, Üst ekstremite somatik blokları, In: Özyalçın S, editor. Rejyonel Anestezi, 1st ed. İstanbul; Nobel Tıp Kitabevleri, 2005:83-93
Collier CE. Pain Management in the Pacu.In Jacobsen W K Ed. Manual of Post Anesthesia Care. 1st Ed, Philadelphia: W B Saunders Company, 1992; 195-211.
Lubemm TR, Ivankovich AD, McCarthy RJ. Management of Acute Postoperative Pain. İn: Barash PC, Culler BF, Stoelting RK. editors. Clinical Anesthesia. 3rd ed. Philadelphia: JB Lippincott company; 1995. p. 458-98
Tanaka A, Al-Rstum Z, Leonard SD, et al. Intraoperative intercostal nerve cryoanalgesia improves pain control after descending and thoracoabdominal aortic aneurysm repairs. Ann Thorac Surg 2020; 109: 249-54.
Mirzai H, Tekin L, Alincak H. Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery. Spine 2002; 27: 343-6.
Chekole AT, Kassa AA, Yadeta SA, Aytolign HA Comparison of sequential versus pre mixed administration of intrathecal fentanyl with hyperbaric bupivacaine for patients undergoing elective Caesarean section at Zewditu memorial referral hospital: A prospective cohort study. Ann Med Surg (Lond) 2022; 74: 103313.
Rainov NG, Heudecke V, Burkert W. Longterm intrathecal infusion of drug combinations for chronic back and leg pain. J Pain Symptom Manag 2001; 22: 826-71.
Barnett RA, Ochroch A. Epidural Analgesia: Management and Outcomes. Annals of Long-Term Care 2003; 11: 33–8.
Howard Rf, Hatch Dj, Fitzgerald M. Inflammatory pain and hypersensitivitiy are selectively reversed by epidural bupivacaine anda re
developmentally regulated. Anesthesiology 2001; 95: 421-7.
Foster RH, Markham A. Levobupivacaine: a review of its pharmacology and use as a local anaesthetic. Drugs 2000; 59; : 551-79.
Morrison SG, Dominguez JJ, Frascarola P, et al. A comparison of the electrocardiographic cardiotoxic effets of racemic bupivacaine,
levobupivacaine, and ropivacaine in anesthetized swine. Anesth and Analg 2000; 90: 1308-14.
Okuda J, Suzuki T, Wakaizumi K, Kato J, Yamada T, Morisaki H. Effects of thoracic epidural anesthesia on systemic and local inflammatory responses in patients undergoing lung cancer surgery: a randomized controlled trial. J Cardiothorac Vasc Anesth 2022; 36: 1380-6.
Huang YF , Pryor ME, Mather LE, Veering BT cardiovascular and central nervous system effects of intravenous levobupivacaine and bupivacaine in sheep. Anesth Analg 1998; 86: 797-804.
Gristwood RW, Greaves JL. Levobupivacaine: a new safer long acting local anaesthetic agent. Expert Opin Invest Drung 1999; 8: 861-76
Camorcia, M. Capogna G. Epidural levobupivakain, ropivakain and bupivacaine in combination with sufentanil in early labour. Eur J
Anaesthesiol 2003; 20: 636-9.
Leone S, DiCianni S, Casati A, Fanelli G. Pharmacology, toxicology and clinical use of new long acting local anesthetics, ropivacaine and levobupivacaine (review). Acta Biomed 2008; 79: 92-105.
Whiteside R, Jones D, Bignell S, et al. Epidural ropivacaine with fentanyl following major gynaecological surgery: the effect of volume and concentration on pain relief and motor impairment. Brit J Anaesth 2000; 84: 720-4.
Dernedde M, Stadler M, Bardiau F, Boogaerts JG. Continuous epidural infusion of large concentration/small volume versus small concentration/ large volume of levobupivacaine for postoperative analgesia. Anesth Analg 2003; 96: 796-801.
Bielewicz J, Daniluk B, Kamieniak P. VAS and NRS, same or different?are visual analog scale values and numerical rating scale equally viable tools for assessing patients after microdiscectomy? Pain Res Manag 2022; 2022: 5337483.
Chen C, Cavanaugh J M, Song Z, Takebayashi T, Kallakuri S, Wooley PH. Effects of nucleus pulposus on nerve root neural activity,
mechanosensitivitiy, axonal morphology and sodium channel expression. Spine 2004; 29: 17-25.21.
Hida S, Naito M, Kubo M. Intraoperative measurements of nerve root blood flow during discectomy for lumbar disc herniation. Spine 2003; 28: 85-90.
Song Y, Li C, Guan J, et al. Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review. Korean J Pain 2022; 35: 97-105.
Cornefjord M, Olmarker K, Otani K, Rydevik B: Nucleus pulposus –induced nerve root injury: effects of diclofenac and ketoprofen. Eur Spine J 2002; 11: 57-61
Lotfinia I, Khallaghi E, Meshkini A, Shakeri M, Shimia M, Safaeian A. Intraoperative use of epidural methylprednisolone or bupivacaine for postsurgical lumbar discectomy pain relief: A randomised, placebo controlled trial. Ann Saudi Med 2007; 27: 279-83.
How to Cite
Copyright (c) 2022 Kastamonu Medical Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.