Intraoperative perineural infiltration of lidocaine for acute postlaminectomy pain: preemptive analgesia in spinal surgery.

STUDY DESIGN

Prospective, cohort, and clinical study.

SUMMARY OF BACKGROUND DATA

It was proven that effective control of postoperative pain in lumbar disk surgery improves the patient's recovery. Despite the many advances in surgical and nonsurgical techniques, the most accurate approach in pain relief is still under debate.

OBJECTIVE

In this study, our aim was to determine whether neural root blockade before the onset of noxious stimuli could inhibit the production of pain.

METHODS

Forty-five patients undergoing unilateral 1 spinal level (lumbar 5) hemipartial laminectomy were included in the study. In 20 of the patients (group 2), 0.5 mL 2% lidocaine was infiltrated onto the neural root immediately after the exposure; the 25 patients in the control group (group 1) were not injected. All patients were monitored regarding pain determination using a visual analog scale, and the exact time of analgesic requirement during the first postoperative day was noted. Total analgesic dose given during the first postoperative day was also recorded.

RESULTS

Perineural lidocaine infiltration extended the early postoperative analgesic period. Although the pain was not completely suppressed, the lidocaine infiltration helped to manage the postoperative pain more effectively. The patients (group 2) who received lidocaine infiltration intraoperatively onto the neural root had a statistically significant longer time before analgesia requested (P<0.001) and also required significantly less analgesic when compared with the control group (P<0.001).

CONCLUSIONS

For preemptive analgesia for acute postoperative pain in laminectomy surgery, which remains a major concern, we suggest that lidocaine infiltration onto the dorsal neural sheath immediately before retraction of the root may extend the time before analgesia requested and the total analgesic drug consumption.