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The Effect of Dexmedetomidine Added to Preemptive Ropivacaine Infiltration on Postoperative Pain after Lumbar Fusion Surgery: A Randomized Controlled Trial.

STUDY DESIGN
A prospective and controlled study of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery.


OBJECTIVE
Assessment of dexmedetomidine added to preemptive ropivacaine infiltration for the relief of postoperative pain after lumbar fusion surgery.


SUMMARY OF BACKGROUND DATA
Single local anesthetic preemptive wound infiltration for the relief of postoperative pain does not translate into major or consistent clinical benefits after lumbar fusion surgery. Dexmedetomidine added to local anesthetics prolonged the duration of blockade and enhanced the analgesic in peripheral nerve block. The effect of dexmedetomidine added to preemptive ropivacaine infiltration in lumbar fusion surgery for the relief of postoperative pain has yet not been studied.


METHODS
Fifty-seven patients with elective posterior lumbar fusion were randomly divided into two groups. 5 minutes before incision, the skin and subcutaneous tissues were injected with 20 mL 0.5% ropivacaine in group R (n = 28) and 20 mL 0.5% ropivacaine and 1ug/kg of dexmedetomidine in group RD (n = 29) in two divided doses (i.e. 10 mL per side of the incision line). After the operation, all patients received intravenous morphine for analgesia. The total morphine consumption, the time of first analgesic demand, numbers of PCA analgesia, Visual Analog Scale, and postoperative adverse effects were collected.


RESULTS
In group RD, cumulative morphine dose and numbers of PCA analgesia in group RD were significantly reduced, the time of first analgesic demand was significantly delayed compared to the group R. Visual Analog Scale in group RD showed a marked reduction at 8 h, 12 h, 16 h after operation and less patients in group RD experienced postoperative nausea or vomiting compared to the group R.


CONCLUSION
The addition of dexmedetomidine to preemptive ropivacaine wound infiltration provided a superior analgesic effect, reduced postoperative morphine consumption, and prolonged the time of the first analgesic demand with no serious side effects.


LEVEL OF EVIDENCE
2.