Postoperative continuous paravertebral anesthetic infusion for pain control in posterior cervical spine surgery

a case-control study.

James B. Elder, Daniel J. Hoh, Charles Y. Liu, Michael Y. Wang

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

INTRODUCTION: Patients who undergo posterior cervical spinal fusion procedures frequently experience significant postoperative pain. Use of a local anesthetic continuous infusion pump after surgery may improve these outcome variables. METHODS: After posterior cervical spine fusion procedures, 25 consecutive patients received continuous infusion of 0.5% bupivacaine into the subfascial aspects of the wound via an elastomeric pump. Data were collected prospectively by third party assessment using standard nursing protocols. This included numeric pain scores and opiate use over the first 4 postoperative days (PODs), length of hospitalization, and complications. In a retrospective analysis, we compared each study patient to a control patient who did not receive the continuous infusion of bupivacaine. Demographic variables and surgical procedure were similar among matched cases. RESULTS: Patients receiving continuous local anesthetic infusion used significantly less narcotics (P < .05) during the first 4 PODs: 24.4% on day 1, 34.1% on day 2, 53.5% on day 3, and 58.1% on day 4. A lower average pain score was observed among study patients on each POD (P < .05): 31.5% less on day 1, 13.0% on day 2, 24.0% on day 3, and 35.7% on day 4. Patients with the infusion device were discharged home earlier (POD 4.9 versus 6.7; P = .024) and demonstrated improvement in time to ambulation, first bowel movement, and discontinuation of the patient-controlled analgesia machine. No complications were associated with the device. CONCLUSION: Patients with the local anesthetic continuous infusion device required less narcotics and reported lower pain scores than control patients on each of the first 4 PODs. These results suggest that continuous infusion of local anesthetic into the paravertebral tissue during the immediate postoperative period is a safe and effective technique that achieves lower pain scores and narcotic use and improves multiple postoperative outcome variables.

Original languageEnglish
JournalNeurosurgery
Volume66
Issue number3 Suppl Operative
StatePublished - Mar 1 2010
Externally publishedYes

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Anesthetics
Case-Control Studies
Spine
Pain
Local Anesthetics
Narcotics
Bupivacaine
Equipment and Supplies
Opiate Alkaloids
Nursing Assessment
Infusion Pumps
Patient-Controlled Analgesia
Spinal Fusion
Postoperative Pain
Postoperative Period
Walking
Hospitalization
Demography
Wounds and Injuries

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Postoperative continuous paravertebral anesthetic infusion for pain control in posterior cervical spine surgery : a case-control study. / Elder, James B.; Hoh, Daniel J.; Liu, Charles Y.; Wang, Michael Y.

In: Neurosurgery, Vol. 66, No. 3 Suppl Operative, 01.03.2010.

Research output: Contribution to journalArticle

Elder, James B. ; Hoh, Daniel J. ; Liu, Charles Y. ; Wang, Michael Y. / Postoperative continuous paravertebral anesthetic infusion for pain control in posterior cervical spine surgery : a case-control study. In: Neurosurgery. 2010 ; Vol. 66, No. 3 Suppl Operative.
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abstract = "INTRODUCTION: Patients who undergo posterior cervical spinal fusion procedures frequently experience significant postoperative pain. Use of a local anesthetic continuous infusion pump after surgery may improve these outcome variables. METHODS: After posterior cervical spine fusion procedures, 25 consecutive patients received continuous infusion of 0.5{\%} bupivacaine into the subfascial aspects of the wound via an elastomeric pump. Data were collected prospectively by third party assessment using standard nursing protocols. This included numeric pain scores and opiate use over the first 4 postoperative days (PODs), length of hospitalization, and complications. In a retrospective analysis, we compared each study patient to a control patient who did not receive the continuous infusion of bupivacaine. Demographic variables and surgical procedure were similar among matched cases. RESULTS: Patients receiving continuous local anesthetic infusion used significantly less narcotics (P < .05) during the first 4 PODs: 24.4{\%} on day 1, 34.1{\%} on day 2, 53.5{\%} on day 3, and 58.1{\%} on day 4. A lower average pain score was observed among study patients on each POD (P < .05): 31.5{\%} less on day 1, 13.0{\%} on day 2, 24.0{\%} on day 3, and 35.7{\%} on day 4. Patients with the infusion device were discharged home earlier (POD 4.9 versus 6.7; P = .024) and demonstrated improvement in time to ambulation, first bowel movement, and discontinuation of the patient-controlled analgesia machine. No complications were associated with the device. CONCLUSION: Patients with the local anesthetic continuous infusion device required less narcotics and reported lower pain scores than control patients on each of the first 4 PODs. These results suggest that continuous infusion of local anesthetic into the paravertebral tissue during the immediate postoperative period is a safe and effective technique that achieves lower pain scores and narcotic use and improves multiple postoperative outcome variables.",
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N2 - INTRODUCTION: Patients who undergo posterior cervical spinal fusion procedures frequently experience significant postoperative pain. Use of a local anesthetic continuous infusion pump after surgery may improve these outcome variables. METHODS: After posterior cervical spine fusion procedures, 25 consecutive patients received continuous infusion of 0.5% bupivacaine into the subfascial aspects of the wound via an elastomeric pump. Data were collected prospectively by third party assessment using standard nursing protocols. This included numeric pain scores and opiate use over the first 4 postoperative days (PODs), length of hospitalization, and complications. In a retrospective analysis, we compared each study patient to a control patient who did not receive the continuous infusion of bupivacaine. Demographic variables and surgical procedure were similar among matched cases. RESULTS: Patients receiving continuous local anesthetic infusion used significantly less narcotics (P < .05) during the first 4 PODs: 24.4% on day 1, 34.1% on day 2, 53.5% on day 3, and 58.1% on day 4. A lower average pain score was observed among study patients on each POD (P < .05): 31.5% less on day 1, 13.0% on day 2, 24.0% on day 3, and 35.7% on day 4. Patients with the infusion device were discharged home earlier (POD 4.9 versus 6.7; P = .024) and demonstrated improvement in time to ambulation, first bowel movement, and discontinuation of the patient-controlled analgesia machine. No complications were associated with the device. CONCLUSION: Patients with the local anesthetic continuous infusion device required less narcotics and reported lower pain scores than control patients on each of the first 4 PODs. These results suggest that continuous infusion of local anesthetic into the paravertebral tissue during the immediate postoperative period is a safe and effective technique that achieves lower pain scores and narcotic use and improves multiple postoperative outcome variables.

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