LOCAL WOUND INFILTRATION WITH BUPIVACAINE IN LUMBAR LAMINECTOMY

BACKGROUND Parenteral administration of narcotics has been the mainsta y for postoperative pain relief in patients undergoing lumbar laminect omy. However, this may lead to respiratory depression and nausea, whic h may be hazardous in these patients. METHODS We evaluated the efficac y of wound infiltration with bupivacaine in 45 consecutive patients un dergoing elective single-level lumbar laminectomy for intervertebral d isc prolapse in a prospective, double-blind, randomized controlled tri al. Prior to wound closure, the muscle and subcutaneous tissues were i nfiltrated with bupivacaine 0.375% or sterile physiologic saline, Post operatively, the patients were assessed hourly for pain and an analges ic administered if the patient had moderate or severe pain. RESULTS Al l the 21 placebo recipients required analgesics in the first 9 hours p ostoperatively, compared to only 11 of 24 patients who received bupiva caine (p < 0.001). The mean (standard deviation) time before administr ation of the first dose of analgesic postoperatively in the bupivacain e and placebo recipients was 807.7 (567.6) minutes and 181.4 (110.1) m inutes, respectively (p < 0.001). No adverse effects of local wound in filtration were noted. CONCLUSIONS Local wound infiltration with bupiv acaine is a safe and effective method for providing postoperative pain relief and reducing narcotic use in patients undergoing lumbar lamine ctomy. (C) 1997 by Elsevier Science Inc.