Postoperative analgesic effect of bupivacaine infiltration following lumbar disc surgery

Abstract

Objectives: Effectiveness of 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and subcutaneous tissue on postoperative pain control was analyzed in patients undergoing lumbar microdiscectomy. Methods: Sixty adult patients scheduled to undergo elective, single-level lumbar discectomy were randomly divided into four groups: the c ontrol group (Control), the subcutaneous tissue group (Group C), which received 20 ml of 0.5% bupivacaine in the subcutaenous tissue, the superficial fascia group (Group F), which received 12 ml bupivacaine in the subcutaneous tissue and 8 ml in the space below the lumbar superficial fascia, and the dura group (Group D), which received a total of 20 ml (100 mg) of bupivacaine, consisting of 10 ml in the subcutaneous tissue, 8 ml in the space below the lumbar superficial fascia, and 2 ml on the dura . Visual Analog Scale Values (VAS) on postoperative 0, 15, 30, 45 minutes, at 1, 2, 4, 6, 12 and 24^th hour and time of the first analgesic need were evaluated for all patients and recorded. Results: While mean VAS value measured at min 0 (as soon as the patient awakened) was 2.3 ± 1.2 in Group D; it was 2.7 ± 0.9 in Group C; 2.7 ± 1.0 in Group F and 3.1 ± 0.6 in control group (p = 0.232). At the end of 1^th hour, mean VAS value was recorded as 2.8 ± 1.0 in Group D; 3.6 ± 1.5 in Group C; 3.6 ± 1.1 in Group F and 4.4 ± 1.1 in control group (p = 0.005). In Group D, 0.5% bupivacaine administered as 2, 8, 10 ml onto dura, fascia and subcutaneously was detected to provide significantly lower VAS values and significantly longer first analgesic need time. Conclusions: 0.5% bupivacaine administered onto dura, under lumbar superficial fascia and in subcutaneous tissue was detected to be a simple, effective and safe method in lumbar microdiscectomy operations.