title: Opioid sparing effect of epidural levobupivacaine on postoperative pain treatment in major spinal surgery.
abstract: 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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anaesthesiology, Intensive Careand Perioperative Medicine, Christian Doppler Klinik, Paracelsus Medical University Salzburg, Austria. a.f.unterrainer@salk.at
authors.forename: A F
authors.initials: AF
authors.lastname: Unterrainer
authors.forename: A R
authors.initials: AR
authors.lastname: Al-Schameri
authors.forename: W P
authors.initials: WP
authors.lastname: Piotrowski
authors.forename: M A
authors.initials: MA
authors.lastname: Krombholz-Reindl
authors.forename: A L
authors.initials: AL
authors.lastname: Schmid
authors.forename: W
authors.initials: W
authors.lastname: Hitzl
mesh_terms: D000368:Aged; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000601:surgery; D007902:Length of Stay; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010892:Pirinitramide / Q000008:administration & dosage / Q000627:therapeutic use; D011446:Prospective Studies; D016037:Single-Blind Method; D013123:Spinal Fusion; D013131:Spine / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077554:Levobupivacaine; D002045:Bupivacaine