ANALYSIS OF EFFICACY OF LOCAL APPLICATION OF BUPYVOCAINE WITH EPINEFRIN DURING MULTILEVEL DECOMPRESSIVE-STABILIZING INTERVENTIONS ON THE LUMBOSACRAL SPINE
Multilevel decompressive-stabilizing interventions on the lumbosacral spine are quite aggressive and require long-term analgesia in the early postoperative period, including that with narcotic analgesics. All of the above factors contribute to the limitation of physical activity, the prolongation of the hospital stay, and an increased risks of thromboembolic and hypostatic complications in the early postoperative period. In order to reduce the severity of the pain syndrome at the surgical intervention site in patients after decompressive-stabilizing interventions on the lumbosacral spine, prolonged local anesthesia with bupivokain and epinephrine before suturing the wound was introduced into the therapeutic process. The purpose of the study is to analyze the effectiveness of local application of bupivokain with epinephrine while performing multi-level decompressive-stabilizing interventions on the lumbosacral spine. Materials and methods. The study included 178 patients who underwent decompressive-stabilizing neurosurgical interventions on 3 vertebral-motor segments for degenerative diseases of the lumbosacral spine; patients were divided into 2 study groups. The main group (n = 82) consisted of patients who underwent a local infiltration anesthesia of paraspinal musculature, subcutaneous tissue and skin with a 0,5% bupivacaine solution with epinephrine 1:200,000 (30 ml) before suturing the wound. The reference group (n = 96) consisted of patients operated without a local anesthetic. Gender characteristics (gender, age), constitutional features (height, weight, body mass index), technical parameters of the intervention (duration of the operation, volume of blood loss, cut length), activation time and duration of inpatient treatment after surgery, as well as complications were investigated for the analysis. The following parameters were also studied: the severity of the pain syndrome based on the visual analogue scale (VAS), which was monitored for the first 10 days after the operation every 24 hours; the need for analgesics for the daily number of injections of non-steroidal anti-inflammatory drugs; the glucose level before the surgery and during the first 3 days after the operation; the degree of patient's satisfaction with the surgery examined using the Macnab scale at discharge. Results. The comparative analysis did not demonstrate any intergroup difference in sex, age and constitutional features, and technical characteristics (p > 0,05). At the same time, statistically significant early activation of patients (p = 0,02) was recorded with a reduction in the hospital stay (p = 0,03) in the main group. When analyzing the severity of the pain syndrome at the operative intervention site using VAS, a significantly lower level was observed in the main group both within the first 72 hours (p = 0,001) and by the time of discharge (p = 0,03). Therefore, the patients of the main group had a significantly lower total need for the administration of analgesics throughout the hospital stay (p= 0,003) as compared with the reference group. According to the Macnab subjective satisfaction scale assessed at discharge, the proportion of good and excellent results was 89% in the main group (n = 73) and 60% in the reference group (n = 56). The efficacy of the local application of bupivokaine with epinephrine was confirmed by a significantly lower blood glucose level in the main group as a marker of a "surgical stress". In the main group, 1 complication (1.2%) was verified and no side effects of drugs for infiltration anesthesia were registered; 10 complications (10,4%) were registered in the reference group (p < 0,001). Conclusion. The study demonstrated a high clinical effectiveness of local application of bupivokaine with epinephrine in the relief of local postoperative pain and early rehabilitation of patients when performing multi-level decompressive-stabilizing interventions on the lumbosacral spine and the absence of adverse drug effects.
About the authorsByvaltsev Vadim A.
Byval'tsev V.A., Goloborod'ko V.Yu., Kalinin A.A., Strelkov M.V., Borisov V.E. Analysis of the use of tranexamic acid in performing multilevel decompressive-stabilizing interventions on the lumbosacral spine. Anesteziologiya i reanimatologiya. 2017; 62(4): 263-8. (in Russian)
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