Pre-emptive Incision Infiltration Versus Post-Operative Wound Infiltration with 0.5% ropivacaine in Patients Undergoing Lumbar Laminectomy

Post-operative pain relief after lumbar laminectomy and stabilization surgery is related to soft tissue and muscle dissection, manipulation and removal at the operating site.

The present study is designed to evaluate the pre-emptive effect of 0.5% Ropivacaine infiltration in patients undergoing lumbar laminectomy

In this prospective, randomized study, seventy five patients belonging to ASA I and ASA II were randomly allocated to three groups as group A, group B and group C. After conventional general anesthesia, patients were kept in prone position. Patients belonging to group Areceived 2 mg/kg of 0.5% ropivacaine before incision and patients belonging to Group B received the same as wound infiltration before closure and group C patients received 10 ml saline infiltration at closure. Injection diclofenac sodium intravenous was given as a rescue analgesia when required. We observed pain intensity with Visual Analogue Scale (VAS) at 0, 30 minutes and 1, 3, 6, 12, 16 hrs, time for first analgesic requirement, total diclofenac sodium consumption and incidence of nausea and vomiting.

Mean VAS score immedietly after the surgery for group A was (2.3±1.8) significantly lower than group B(5.0±1.9, P=0.0001) and group C(6.6±2.3, P=0.0001). First analgesic dose requirement time was longer in group A (120±21min) than group B(60.3±20.1 min, P=0.0001) and group C(10±19.3 min, P=0.0001). Total amount of diclofenac sodium required in group A(65.8±20.8mg) was less than group B(110±25.8mg, P=0.0001) and group C(141±22.1mg, P=0.0001). Incidence of nausea and vomiting were equal in all the groups.

Infiltration with 0.5% Ropivacaine significantly decreses post-operative pain intensity and diclofenacsodium consumption. Infiltration has better effect when given pre-emtively.