title: Preemptive Caudal Ropivacaine: An Effective Analgesic during Degenerative Lumbar Spine Surgery.
abstract: METHODS
  This was a prospective, randomized, controlled trial comprising 60 patients undergoing lumbosacral spine (noninstrumentation/nonfusion) surgery.
  
  
  OBJECTIVE
  The purpose of this study was to evaluate the efficacy of 0.2% ropivacaine (20 mL) administered alone as a single, preoperative, caudal epidural block injection versus that of intravenous analgesics in providing effective postoperative analgesia to patients undergoing lumbosacral spine surgery.
  
  
  BACKGROUND
  Various studies have shown the effectiveness of a caudal epidural injection (bupivacaine or ropivacaine) in providing postoperative analgesia in combination with steroids or other analgesics. This study uniquely analyzed the efficacy of a single injection of caudal epidural ropivacaine in providing postoperative pain relief.
  
  
  METHODS
  Sixty patients who were scheduled to undergo surgery for degenerative lumbar spine disease (noninstrumentation/nonfusion) were consecutively divided into two groups, group R (Study) and group I (Control). 30 group R patients received a caudal epidural block with 20 mL of 0.2% ropivacaine after the administration of general anesthesia. 30 group I patients received no preoperative analgesia. Intravenous analgesics were administered during the postoperative period after a complaint of pain. Various parameters indicating analgesic effect were recorded.
  
  
  RESULTS
  There was a significant delay in the average time to the first demand for rescue analgesia in the study group, suggesting significantly better postoperative pain relief than that in the control group. In comparison with the control group, the study group also showed earlier ambulation with minimal adverse effects. The requirement for intraoperative fentanyl was higher in the control group than that in the study group.
  
  
  CONCLUSIONS
  Preemptive analgesia with a single epidural injection of ropivacaine is a safe, simple, and effective approach, providing better postoperative pain relief, facilitating early mobilization, and decreasing the intraoperative requirement for opioid administration.
authors.affiliation: Department of Neurosurgery, Vydehi Institute of Medical Science, Bangalore, India.
authors.forename: Shashwat
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Neurosurgery, Vydehi Institute of Medical Science, Bangalore, India.
authors.forename: Jagannath Manickam
authors.initials: JM
authors.lastname: Palaniappan
authors.affiliation: Department of Neurosurgery, Vydehi Institute of Medical Science, Bangalore, India.
authors.forename: Anantha
authors.initials: A
authors.lastname: Kishan
keywords: Caudal anesthesia; Degenerative disease; Lumbar; Ropivacaine; Spine