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Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study

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Abstract

Purpose

There has been a growing interest in continuous local anaesthetic wound infiltration as a non-opioid technique for postoperative pain relief. The impact of this modality on baseline analgesia after spinal fusion surgery has however been inconclusive. We tested whether continuous wound infiltration with ropivacaine can enhance postoperative analgesia compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery.

Methods

In this randomized, double-blinded, placebo-controlled study, a multiholed 19-gauge catheter was placed at the end of the surgical procedure through the wound to permit the continuous administration (8 ml/h) of ropivacaine 0.2 % (ropivacaine group; n = 19 patients) or saline (control group; n = 20 patients) during the first 48 postoperative hours (H48). Both groups received intraoperative low-dose ketamine, a combination of acetaminophen, non-steroidal anti-inflammatory drug, and nefopam over the same postoperative period, and morphine delivered by a patient-controlled analgesia (PCA) device.

Results

Morphine consumption was comparable between the two groups both at H48, 38 mg (26:52) (median, 25th:75th percentile) (control group) versus 43 mg (19:74) (ropivacaine group), and at H24, 18 mg (16:22) versus 22 mg (9:35) respectively. Pain scores at rest and during mobilization, quality of postoperative sleep, and morphine-related side effects were comparable between the two groups at H24 and H48.

Conclusion

Our findings indicate that no additional analgesia was provided with continuous wound infiltration of ropivacaine compared to a baseline intravenous multimodal analgesia protocol after spinal fusion surgery.

Trial registration

Clinicaltrials.gov #NCT01743794.

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Acknowledgments

Assistance: the authors wish to thank Celine Genty and Kristina Skaare (Clinical Research Centre, INSERM 003, Hôpital Michallon, Grenoble) for their assistance in the statistical analysis, and Marie Joyeux-Faure (Department of Pharmacy, Hôpital Michallon, Grenoble) for her help in preparing blinded treatments. We thank also Dr. Marie Frost (Department of Anaesthesiology and Critical Care, Hôpital Michallon, Grenoble) for her assistance in the study.

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Author notes

    Authors and Affiliations

    1. Department of Anesthesia and Critical Care, CHU Grenoble Alpes, 38000, Grenoble, France

      Jules Greze, Arnaud Vighetti, Pascal Incagnoli, Pierre Albaladejo & Jean-Francois Payen

    2. Clinical Research Centre, INSERM 003, CHU Grenoble Alpes, 38000, Grenoble, France

      Jean-Louis Quesada & Jean-Luc Bosson

    3. Department of Neurosurgery, CHU Grenoble Alpes, 38000, Grenoble, France

      Olivier Palombi

    4. Univ Grenoble Alpes, Laboratoire Jean Kuntzmann, CNRS UMR 5224, INRIA , 38334, Saint-Ismier, France

      Olivier Palombi

    5. Department of Orthopaedics, CHU Grenoble Alpes, 38000, Grenoble, France

      Jerome Tonetti

    6. Univ Grenoble Alpes, CNRS-TIMC-IMAG UMR , 5525-ThEMAS, 38000, Grenoble, France

      Pierre Albaladejo & Jean-Luc Bosson

    7. Univ Grenoble Alpes, Grenoble Institut des Neurosciences, GIN, 38000, Grenoble, France

      Jean-Francois Payen

    8. INSERM, U1216, 38000, Grenoble, France

      Jean-Francois Payen

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    1. Jules Greze
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    Correspondence to Jean-Francois Payen.

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    This work was supported by institutional funding from the Delegation à la Recherche Clinique et à l’Innovation (DRCI), University Grenoble Hospital.

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    Jules Greze and Arnaud Vighetti contributed equally to the work.

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    Greze, J., Vighetti, A., Incagnoli, P. et al. Does continuous wound infiltration enhance baseline intravenous multimodal analgesia after posterior spinal fusion surgery? A randomized, double-blinded, placebo-controlled study. Eur Spine J 26, 832–839 (2017). https://doi.org/10.1007/s00586-016-4428-1

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    • DOI: https://doi.org/10.1007/s00586-016-4428-1

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