Opioid sparing effect of epidural levobupivacaine on postoperative pain treatment in major spinal surgery.

BACKGROUND AND OBJECTIVE Continuous epidural administration of a local anesthetic drug for postoperative pain treatment of patients, who undergo a fusion operation of lumbar vertebrae is limited by the suction of wound drainage. The effect of the single epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure was examined on the postoperative demand for piritramide. METHODS The study was conducted in a prospective, single blind and randomized manner. Forty patients scheduled for posterior intervertebral body fusion of two or three vertebrae were divided into two groups. Group A received levobupivacaine 0.25% 10 mL epidurally, Group B received piritramide 0.08 mg kg(-1) i.v. Time of administration was 20 minutes before predicted finish of skin closure in both groups. Piritramide was administered intravenously to achieve a VAS of 3 or less during the phase of awakening. After regaining of co-operativity, piritramide was self administered via PCA pump. VAS and the demand of piritramide within 12 hours postoperative were recorded. RESULTS VAS at the time of being approachable (P = 0.23), VAS at the time of regaining co-operativity (P = 0.53) and VAS 12 hours postoperative (P = 0.27) did not differ significantly. The postoperative demand of piritramide was significantly lower in Group A (0.36 +/- 0.25 mg kg(-1) vs. 0.52 +/- 0.19 mg kg(-1) in Group B) (P = 0.026). CONCLUSION The epidural administration of levobupivacaine 0.25% 10 mL 20 minutes before finishing of skin closure effects opioid sparing in the pain treatment of patients undergoing posterior interbody fusion of two or three vertebrae.