European Spine Journal

, 17:1237 | Cite as

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

  • Alp GurbetEmail author
  • Ahmet Bekar
  • Hulya Bilgin
  • Gulsen Korfali
  • Selcuk Yilmazlar
  • Mehmet Tercan
Original Article


This is a prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with levobupivacaine or levobupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. The objective of the study was to determine the efficacy of preemptive wound infiltration with levobupivacaine and levobupivacaine-methylprednisolone at the surgical site for pain relief. Patients usually suffer significant pain after lumbar discectomy. Wound infiltration with local anesthetics with or without corticosteroids is one method to address this. A total of 100 patients were randomly allocated to five equal groups as follows: Group I had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group II had the same region infiltrated with 30 mL 0.25% levobupivacaine alone before closure; Group III had this region infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV this region was infiltrated with 30 mL 0.25% levobupivacaine alone before incision; and in Group C (controls) this region was infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores and morphine usage were recorded. All four treatment groups showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of levobupivacaine or levobupivacaine-methylprednisolone into the muscle near the operative site provides more effective analgesia after lumbar discectomy. Our data suggest that preemptive infiltration of the wound site with levobupivacaine alone or combined with methylprednisolone provides effective pain control with reduced opiate dose after unilateral lumbar discectomy.


Preemptive analgesia Wound infiltration Lumbar discectomy Levobupivacaine Methylprednisolone 


  1. 1.
    Bay Nielsen M, Klarskov B, Bech K, Andersen J, Kehlet H (1999) Levobupivacaine versus bupivacine as infiltration anesthesia in inguinal herniorraphy. Br J Anaesth 82:280–282PubMedGoogle Scholar
  2. 2.
    Bisgaard T, Klarskov B, Bjerregaard K et al (1999) Multi regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multimodal analgesia: a randomized, double-blind, placebo-controlled study. Anesth Analg 89:1017–1024PubMedCrossRefGoogle Scholar
  3. 3.
    Buchman AL (2001) Side effects of corticosteroids therapy. J Clin Gastroenterol 33:289–293PubMedCrossRefGoogle Scholar
  4. 4.
    Cherian MN, Mathews MP, Chandy MJ (1997) Local wound infiltration with bupivacaine in lumbar laminectomy. Surg Neurol 47:120–122PubMedCrossRefGoogle Scholar
  5. 5.
    Crastein BN, Kimmel SC, Levin RI et al (1992) A mechanism for the anti-inflammatory effects of corticosteroids: the glucocorticoid receptor regulates leukocyte adhesion to endothelial cells and expression of endothelialleukocyte adhesion molecule-1 and intercellular adhesion molecule-1. Proc Natl Acad Sci USA 89:9991–9995CrossRefGoogle Scholar
  6. 6.
    Ersayli DT, Gurbet A, Bekar A, Uckunkaya N, Bilgin H (2006) Effects of perioperatively administered bupivacaine and bupivacaine-methylprednisolone on pain after lumbar discectomy. Spine 31:2221–2226PubMedCrossRefGoogle Scholar
  7. 7.
    Foster RH, Markham A (2000) Levobupivacaine: a review of its pharmacology and use as a local anesthetic. Drugs 59:551–579PubMedCrossRefGoogle Scholar
  8. 8.
    Glaser C, Marhofer P, Zimpfer G et al (2002) Levobupivacaine versus racemic bupivacaine for spinal anesthesia. Anesth Analg 94:194–198PubMedCrossRefGoogle Scholar
  9. 9.
    Glasser RS, Knego RS, Delashaw JB et al (1993) The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease. J Neurosurg 78:383–387PubMedGoogle Scholar
  10. 10.
    Gust R, Pecher S, Gust A et al (1992) Effect of patient-controlled analgesia on pulmonary complications after coronary artery bypass grafting. Crit Care Med 27:2218–2223CrossRefGoogle Scholar
  11. 11.
    Jayr C, Mollie A, Bourgain JL et al (1988) Postoperative pulmonary complications: general anesthesia with postoperative parenteral morphine. Surgery 104:57–63PubMedGoogle Scholar
  12. 12.
    Johansson B, Hallerback B, Stubberod A et al (1997) Preoperative local infiltration with ropivacaine for postoperative pain relief after inguinal hernia repair: a randomized controlled trial. Eur J Surg 163:371–378PubMedGoogle Scholar
  13. 13.
    Kehlet H (1991) Neurohumoral response to surgery and pain in men. In: Bond MR, Charlton JI, Woolf CJ (eds) Proceedings of the VI World Congress on Pain, Amsterdam. Elsevier, Amsterdam, pp 412–421Google Scholar
  14. 14.
    Lewis DL, Thompson WA (1953) Reduction of postoperative pain. Br Med J 1:973–974PubMedGoogle Scholar
  15. 15.
    Milligan KR, Macafee AL, Fogarty DJ, Wallace RG, Ramsey P (1993) Intraoperative bupivacaine diminishes pain after lumbar discectomy: a randomized double-blind study. J Bone Joint Surg Br 75:769–771PubMedGoogle Scholar
  16. 16.
    Morgan GE, Mikhail MS, Murray MJ (2002) Local anesthetics. In: Clinical anesthesiology, 3rd edn. Lange Medical, London, pp 233–241Google Scholar
  17. 17.
    Mullen JB, Cook WA Jr (1979) Reduction of postoperative lumbar hemilaminectomy pain with marcaine. J Neurosurg 51:126–127PubMedCrossRefGoogle Scholar
  18. 18.
    Nelson DA (1993) Intraspinal therapy using methylprednisolone acetate: twenty three years of clinical controversy. Spine 18:278–286PubMedCrossRefGoogle Scholar
  19. 19.
    Pflug AE, Murphy TM, Butler SH et al (1974) The effects of postoperative analgesia on pulmonary therapy and complications. Anesthesiology 41:8–17PubMedCrossRefGoogle Scholar
  20. 20.
    Ramsay MA, Savege TM, Simpson BR et al (1974) Controlled sedation with alphaxalone-alphadolone. BMJ 12:656–659Google Scholar
  21. 21.
    Rosemberg J, Kehlet H (1999) Does effective postoperative pain management influence surgical morbidity. Eur Surg Res 31:133–137CrossRefGoogle Scholar
  22. 22.
    Woolf C, Chong WS (1993) Preemptive analgesia-treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg 77:362–379PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Alp Gurbet
    • 1
    Email author
  • Ahmet Bekar
    • 2
  • Hulya Bilgin
    • 1
  • Gulsen Korfali
    • 1
  • Selcuk Yilmazlar
    • 2
  • Mehmet Tercan
    • 1
  1. 1.Department of Anesthesiology and ReanimationUludag University Faculty of MedicineBursaTurkey
  2. 2.Department of NeurosurgeryUludag University Faculty of MedicineBursaTurkey

Personalised recommendations