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The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain After Lumbar Fusion Surgery

A Randomized Controlled Trial

Li, Jing MD; Yang, Jun-Song MD; Dong, Bu-Huai MD; Ye, Jiu-Min MD

doi: 10.1097/BRS.0000000000003096
RANDOMIZED TRIAL
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Study Design. A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.

Objective. Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.

Summary of Background Data. Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.

Methods. Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. Five minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1 ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e., 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected.

Results. In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 hours, 12 hours, 16 hours after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R.

Conclusion. The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects.

Level of Evidence: 2

Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.

Department of Anesthesiology, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shannxi, China

Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shannxi, China.

Address correspondence and reprint requests to Jing Li, MD, Department of Anesthesiology, Honghui Hospital, Xi’an Jiaotong University, No. 555 East Friendship Road, 710054 Xi’an, Shannxi, China; E-mail: ljgraceful@126.com

Received 24 December, 2018

Revised 28 March, 2019

Accepted 8 April, 2019

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

JL and J-SY contributed equally to this work and as co-first authors.

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