Journal Information
Vol. 19. Issue 1.
Pages 45-49 (January 2008)
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Vol. 19. Issue 1.
Pages 45-49 (January 2008)
Can facet joint infiltrative analgesia reduce postoperative pain in degenerative lumbar disc surgery?
¿Puede reducirse el dolor postoperatorio en la cirugía discal degenerativa lumbar con infiltración de analgésicos?
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G. Bademci
, H. Anbarci, C. Evliyaoglu
Departments of Neurosurgery. Faculty of Medicine. University of Kirikkale. Kirikkale. Turkey
H. Basar***, S. Sahin*, S. Ozcakir*, S. Keskil**
* Departments of Anesthesiology and Reanimation. Faculty of Medicine. University of Kirikkale. Kirikkale. Turkey
** Department of Neurosurgery. Bayindir Medical Center. Ankara, Turkey
*** Department of Anesthesiology and Reanimation. Ankara Hospital. Ankara, Turkey
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Summary
Objective

Perioperative analgesia effects the postoperative course of pain. The purpose of this study was to evaluate its possible relation with the consumption of dolantine and analgesics and the facet-induced pain and postoperative pain score in degenerative disc surgery.

Methods

We employed perioperative intra- and perifacet bupivacaine infiltration technique to reduce the postoperative pain after lumbar disc surgery. The study was randomized and observer blinded enrolling 40 American Society of Anesthesiologists physical status class I-II patients scheduled for elective degenerative lumbar disc surgery. The patients were divided into two groups of 20 of which Group 1 underwent injection of bupivacaine into the subcutaneous and muscular layers around the incision site, while Group 2 underwent additional intra- and perifacetal joint infiltration. Postoperatively, the patients were provided with a programmed patient-controlled pump which was only activated on demand to infuse dolantine for the next 24 hours. In the postanesthesia care unit the delay for analgesia and the dose of dolantine used were recorded.

Results

There was no statistical significance between these two groups regarding postoperative visual analoque scale scores. The time before the first analgesic request was significantly longer in facet group (p=0,006). The cumulative dolantine dose was also significantly lower in the facet group (p=0,001)

Conclusion

The results indicate that facet joint infiltrative analgesia may have an effect on the postoperative analgesic requirement and reduce the dolantine consumption.

Key words:
Analgesia
Facet joint infiltration
Discopathy
Lumbar surgery
Abbreviations:
ASA
NSAID
PACU
PCA
SD
VAS
Resumen
Objetivo

La analgesia peroperatoria influye en el curso del dolor postquirúrgico. El propósito del estudio reside en la evaluación de la posible relación entre el consumo de dolantina y otros analgésicos en el control del dolor postquirúrgico de origen facetario lumbar en la enfermedad discal degenerativa.

Métodos

Empleamos peroperatoriamente infiltraciones percutáneas de bupivacaína intra y perifacetaria para reducir el dolor postoperartorio tras cirugía discal lumbar. El estudio fue randomizado y oculto al observador y se realizó sobre 40 pacientes operados de cirugía electiva por enfermedad degenerativa lumbar, con una situación general Clase I-II de la clasificación de la American Society of Anesthesiologist. Los pacientes se dividieron en dos grupos de 20. El Grupo 1 se le administró bupivacaína en el tejido subcutáneo y capas musculares. El grupo 2 recibió una inyección adicional de bupivacaína intra y perifacetaria. Durante el postoperatorio, los pacientes, dispusieron de una bomba programable de analgesia controlada, que se activó exclusivamente a demanda para infundir dolantina en las 24 horas siguientes a la operación. En la Unidad de Reanimación postquirúrgicas se recogieron las necesidades de dolantina de los distintos pacientes.

Resultados

No se encontraron diferencias estadísticamente significativas entre ambos grupos en relación a los valores de la escala analógica visual. El tiempo de demanda del primer bolo analgésico fue significativamente mayor en el grupo de facetas infiltradas (p=0,006). La acumulación de las dosis de dolantina fue también significativamente inferior en el grupo de facetas infiltradas (p=0.001).

Conclusión

Los resultados indican que la infiltración de la faceta articular con anestésico local puede tener un efecto positivo reduciendo las necesidades analgésicas postoperatorias de dolantina.

Palabras clave:
Analgesia
Infiltración facetaria
Disco lumbar
Cirugía lumbar

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