Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine
Identifieur interne : 001434 ( Main/Exploration ); précédent : 001433; suivant : 001435Analysis of Postoperative Pain at the Anterior Iliac Crest Harvest Site: A Prospective Study of the Intraoperative Local Administration of Ropivacaine
Auteurs : Juliane Zenner [Allemagne] ; Wolfgang Hitzl [Autriche] ; Michael Mayer [Allemagne] ; Heiko Koller [Allemagne]Source :
- Asian Spine Journal [ 1976-1902 ] ; 2015.
Abstract
This was a prospective randomized comparative study.
The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain.
Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported.
Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented.
Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all
VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.
Url:
DOI: 10.4184/asj.2015.9.1.39
PubMed: 25705333
PubMed Central: 4330217
Affiliations:
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sort="Koller, Heiko" uniqKey="Koller H" first="Heiko" last="Koller">Heiko Koller</name><affiliation wicri:level="1"><nlm:aff id="A1">German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen</wicri:regionArea><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25705333</idno><idno type="pmc">4330217</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4330217</idno><idno type="RBID">PMC:4330217</idno><idno type="doi">10.4184/asj.2015.9.1.39</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">002846</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" 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Juliane" uniqKey="Zenner J" first="Juliane" last="Zenner">Juliane Zenner</name><affiliation wicri:level="1"><nlm:aff id="A1">German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen</wicri:regionArea><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion></affiliation></author><author><name sortKey="Hitzl, Wolfgang" sort="Hitzl, Wolfgang" uniqKey="Hitzl W" first="Wolfgang" last="Hitzl">Wolfgang Hitzl</name><affiliation wicri:level="1"><nlm:aff id="A2">Biostatistics, Research Office, Paracelsus Medical University Salzburg, Salzburg, Austria.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Autriche</country><wicri:regionArea>Biostatistics, Research Office, Paracelsus Medical University Salzburg, Salzburg</wicri:regionArea><wicri:noRegion>Salzburg</wicri:noRegion></affiliation></author><author><name sortKey="Mayer, Michael" sort="Mayer, Michael" uniqKey="Mayer M" first="Michael" last="Mayer">Michael Mayer</name><affiliation wicri:level="1"><nlm:aff id="A1">German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen</wicri:regionArea><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion></affiliation></author><author><name sortKey="Koller, Heiko" sort="Koller, Heiko" uniqKey="Koller H" first="Heiko" last="Koller">Heiko Koller</name><affiliation wicri:level="1"><nlm:aff id="A1">German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen, Germany.</nlm:aff><country xml:lang="fr" wicri:curation="lc">Allemagne</country><wicri:regionArea>German Scoliosis Center Bad Wildungen, Werner-Wicker-Klinik, Bad Wildungen</wicri:regionArea><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion><wicri:noRegion>Bad Wildungen</wicri:noRegion></affiliation></author></analytic><series><title level="j">Asian Spine Journal</title><idno type="ISSN">1976-1902</idno><idno type="eISSN">1976-7846</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Study Design</title><p>This was a prospective randomized comparative study.</p></sec><sec><title>Purpose</title><p>The aim of this study was to objectify donor site-related pain following anterior iliac crest graft harvesting, in patients who have undergone multilevel anterior cervical discectomy and fusion with plating (ACDFP); and to assess the effect of an intraoperative local single injection of ropivacaine on postoperative pain.</p></sec><sec><title>Overview of Literature</title><p>Multilevel ACDFP can be associated with a high non-union rate. Autogenous iliac bone has been used to increase union rates, although a high incidence of donor site-related pain has been reported.</p></sec><sec><title>Methods</title><p>Forty consecutive patients who required 3-level or 4-level ACDFP were prospectively assessed for donor site-related pain. Pain levels were assessed daily for five days postoperative using the visual analog scale (VAS). Patients were randomly assigned to group A or B. In group A patients, 7-10 mL of ropivacaine (0.2%) was injected into the iliac crest after iliac crest graft harvesting. Morphine usage via patient controlled analgesia was calculated. At six months postoperative, patient complaints at the harvest site were documented.</p></sec><sec><title>Results</title><p>Patients were randomly assigned to group A or B. In group A, ropivacaine was locally administered at the site of the iliac crest graft harvest after fascia closure. In group B, no additional treatments were administered. The average patient age in group A was 56±7.6 years, whereas the average age of patients in group B was 52.6±10.4 years. Group A had an average of 0.6±0.7 previous surgeries per patient, whereas group B had an average of 0.8±1.0 previous surgeries per patient. The average number of levels fused in group A was 3.6±0.7, whereas the average number of levels fused in group B was 3.7±0.9 (all <italic>p</italic>>0.05). In group A, the mean ropivacaine volume administered was 8.4±1.5 mL. No patient complaints regarding chronic pain, were reported six months postoperatively. No complications were encountered from the harvest site, and all patients underwent successful 3-level and 4-level ACDFP. Statistical analysis showed significant differences for VAS on postoperative day 1 (<italic>p</italic>=0.004) and day 2 (<italic>p</italic>=0.005).</p></sec><sec><title>Conclusions</title><p>VAS assessment showed overall moderate perioperative morbidity in terms of donor site-related pain, which was reduced by administering ropivacaine.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Koller, H" uniqKey="Koller H">H Koller</name></author><author><name sortKey="Hempfing, A" uniqKey="Hempfing A">A Hempfing</name></author><author><name sortKey="Ferraris, L" uniqKey="Ferraris L">L Ferraris</name></author><author><name sortKey="Maier, O" uniqKey="Maier O">O Maier</name></author><author><name sortKey="Hitzl, W" uniqKey="Hitzl W">W Hitzl</name></author><author><name sortKey="Metz Stavenhagen, P" uniqKey="Metz Stavenhagen P">P Metz-Stavenhagen</name></author></analytic></biblStruct><biblStruct><analytic><author><name 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Dadure</name></author><author><name sortKey="Bringuier, S" uniqKey="Bringuier S">S Bringuier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Morgan, Sj" uniqKey="Morgan S">SJ Morgan</name></author><author><name sortKey="Jeray, Kj" uniqKey="Jeray K">KJ Jeray</name></author><author><name sortKey="Saliman, Lh" uniqKey="Saliman L">LH Saliman</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chiono, J" uniqKey="Chiono J">J Chiono</name></author><author><name sortKey="Bernard, N" uniqKey="Bernard N">N Bernard</name></author><author><name sortKey="Bringuier, S" uniqKey="Bringuier S">S Bringuier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Barkhuysen, R" uniqKey="Barkhuysen R">R Barkhuysen</name></author><author><name sortKey="Meijer, Gj" uniqKey="Meijer G">GJ Meijer</name></author><author><name sortKey="Soehardi, A" uniqKey="Soehardi A">A Soehardi</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Allemagne</li><li>Autriche</li></country></list><tree><country name="Allemagne"><noRegion><name sortKey="Zenner, Juliane" sort="Zenner, Juliane" uniqKey="Zenner J" first="Juliane" last="Zenner">Juliane Zenner</name></noRegion><name sortKey="Koller, Heiko" sort="Koller, Heiko" uniqKey="Koller H" first="Heiko" last="Koller">Heiko Koller</name><name sortKey="Mayer, Michael" sort="Mayer, Michael" uniqKey="Mayer M" first="Michael" last="Mayer">Michael Mayer</name></country><country name="Autriche"><noRegion><name sortKey="Hitzl, Wolfgang" sort="Hitzl, Wolfgang" uniqKey="Hitzl W" first="Wolfgang" last="Hitzl">Wolfgang Hitzl</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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