Analgesic Efficacy and Safety of Local Infiltration Following Lumbar Decompression Surgery: A Systematic Review of Randomized Controlled Trials.

Georgia Tsaousi,Eleftheria Palaska,Parmenion P. Tsitsopoulos,Rafael Badenes,Federico Bilotta,Chryssa Pourzitaki

doi:10.3390/jcm10245936

Abstract

This systematic review aims to appraise available clinical evidence on the efficacy and safety of wound infiltration with adjuvants to local anesthetics (LAs) for pain control after lumbar spine surgery. A database search was conducted to identify randomized controlled trials (RCTs) pertinent to wound infiltration with analgesics or miscellaneous drugs adjunctive to LAs compared with sole LAs or placebo. The outcomes of interest were postoperative rescue analgesic consumption, pain intensity, time to first analgesic request, and the occurrence of adverse events. Twelve double-blind RCTs enrolling 925 patients were selected for qualitative analysis. Most studies were of moderate-to-good methodological quality. Dexmedetomidine reduced analgesic requirements and pain intensity within 24 h postoperatively, while prolonged pain relief was reported by one RCT involving adjunctive clonidine. Data on local magnesium seem promising yet difficult to interpret. No clear analgesic superiority could be attributed to steroids. Τramadol co-infiltration was equally effective as sole tramadol but superior to LAs. No serious adverse events were reported. Due to methodological inconsistencies and lack of robust data, no definite conclusions could be drawn on the analgesic effect of local infiltrates in patients undergoing lumbar surgery. The probable positive analgesic efficacy of adjunctive dexmedetomidine and magnesium needs further evaluation.

Highlights

The presence of moderate to intense pain is typical after lumbar spine surgery, which in turn hampers early ambulation, recovery, and rehabilitation [1,2]
The medical subject headings MeSH terms “spine surgery”, “discectomy”, “laminectomy”, “local anesthetics”, “infiltration”, “pain”, “analgesia”, “analgesics”, “opioids”, “ketamine”, “tramadol”, “dexmedetomidine”, “clonidine”, “steroids”, “non-steroidal antiinflammatory drugs (NSAIDs)”, “nonsteroidal anti-inflammatory drug”, “COX-2”, or “magnesium” with “AND” and “OR” as Boolean terms were applied into the databases to retrieve articles relevant to the objectives of the current review
Our analysis indicates that the use of dexmedetomidine as a local anesthetic adjuvant for wound infiltration exerts a positive impact on analgesic requirements and pain intensity up to 24 h after lumbar spine surgery

Summary

Introduction

The presence of moderate to intense pain is typical after lumbar spine surgery, which in turn hampers early ambulation, recovery, and rehabilitation [1,2]. Persistent pain might have serious consequences on patients’ quality of life [1,3] This has produced a growing body of evidence to assess the safety and efficacy of traditional and novel analgesic modalities as effective means to alleviate disabling pain in patients subjected to lumbar spine surgery [4,5,6]. The major concern remains the restricted duration of action from the use of local anesthetics as sole analgesic medications To address this issue, alternative agents, namely opioids, non-steroidal antiinflammatory drugs (NSAIDs), a-2 agents, opioids, steroids, ketamine, or magnesium, have been incorporated in the process of wound infiltration to enhance postoperative pain control [5]

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Discussion

Conclusion