Preemptive Infiltration With Betamethasone and Ropivacaine for Postoperative Pain in Laminoplasty or Laminectomy
- Conditions
- Pain, PostoperativeNeurosurgery
- Interventions
- Drug: The Treatment groupDrug: The Control group
- Registration Number
- NCT04153396
- Lead Sponsor
- Beijing Tiantan Hospital
- Brief Summary
Laminoplasty and laminectomy have been used for decades for the treatment of intraspinal space occupying lesions, spinal stenosis, disc herniation, injuries, etc. After these procedures, patients often experience severe postoperative pain at the surgical site. However, current methods of pain control are mostly insufficient. At present, several pain controlling methods are available, to reduce postoperative pain after laminoplasty or laminectomy. Methods for systemic administration include: oral analgesics, intermittent intravenous, intramuscular injections, patient- controlled intravenous analgesia, etc. However, the aforementioned methods may have a lot of side effects, and are usually used after the occurrence of pain and the analgesic effects are sometimes inadequate. Topical administration options use a lower dose of drugs and therefore have less systemic side effects. Pre-emptive injection of local anesthetics can significantly reduce postoperative pain during rest and movement, however, the analgesic effect is maintained for a relatively short period of time. It is necessary to use more cases to explore the other compatibility of drugs with longer duration of action and stronger analgesic effect. Betamethasone as the stereoisomer of dexamethasone is a long-acting corticosteroid, which has long lasting anti-inflammatory properties. Whether betamethasone combined with local anesthetic for laminoplasty or laminectomy has better short-term and long-term effects than the local anesthetic alone has not been reported yet. Therefore, a prospective, randomized, controlled, blinded-endpoint study is needed to compare the postoperative analgesic efficacy of preemptive wound infilteration of ropivacaine alone and betamethasone plus ropivacaine for laminectomy or laminoplasty.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 116
- Patients scheduled for surgery under general anaesthesia for laminectomy or laminoplasty;
- American Society of Anaesthesiologists (ASA) classification of I or II;
- Age 18 to 64 years;
- Participates with an anticipated full recovery within 2 hours postoperatively.
- Patient refusal;
- Participants who cannot use a patient-controlled analgesia (PCA) device and cannot understand the instructions of a Visual Analogue Score (VAS);
- Previous history of spinal surgery;
- Allergy to opioids, betamethasone or ropivacaine;
- Peri-incisional infection;
- History of stroke or a major neurological deficit;
- Trauma, deformity;
- Psychological problems;
- Extreme body mass index (BMI) (< 15 or > 35);
- History of excessive alcohol or drug abuse, chronic opioid use (more than 2 weeks), or use of drugs with confirmed or suspected sedative or analgesic effects;
- Patients using systemic steroids;
- Pregnant or breastfeeding;
- Preoperative Glasgow Coma Scale < 15;
- Participants who have received radiation therapy or chemotherapy preoperatively, or with a high probability to require a postoperative radiation therapy or chemotherapy according to the preoperative imaging.
- Not able to give written informed consent
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description The Treatment Group The Treatment group The local infiltration solution in the treatment group will consist of betamethasone and ropivacaine. The Control group The Control group The local infiltration solution in the control group will consist of ropivacaine.
- Primary Outcome Measures
Name Time Method The cumulative butorphanol dose during the 48 hours after surgery via the PCA device. Within 48 hours after the operation All participates will receive an electronic intravenous patient-controlled analgesia (PCA) device. Participates will be advised to push the analgesic demand button if they feel pain.
- Secondary Outcome Measures
Name Time Method The Visual Analogue Scale (VAS) during movement (VASm) At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours and 72 hours, and 1 week, 2 weeks, 4 weeks, 6 weeks and 3 months and 6 months after surgery. The pain will be assessed by the visual analogue scale (VAS) scores: an 11-point VAS score during movement (VASm) will be recorded (0 indicates no pain, 10 indicates the most severe pain imaginable, a higher score means worse pain)
The Postoperative Nausea and Vomiting (PONV) At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery The Postoperative Nausea and Vomiting (PONV) will be measured using an ordinal scale, with 0 indicating no nausea; 1, mild nausea not requiring treatment; 2, nausea requiring treatment; 3, vomiting.
The first analgesia demand on the PCA device Within 48 hours postoperatively The time from the end of the surgery to the first administration of analgesia via the PCA device
The World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores At 6 months postoperatively The World Health Organization Quality of Life-BREF (WHOQOL-BREF) scores will be used to obtain scores for four domains related to quality of life: physical health (7 items), psychological (6 items), social relationships (3items) and environment (8items). It will also include two stand-alone questions on overall quality of life and satisfaction with health. Each question will be rated on a scale of 1-5 with higher scores signifying better quality of life.
The Visual Analogue Scale (VAS) at rest (VASr) At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours and 72 hours, and 1 week, 2 weeks, 4 weeks, 6 weeks and 3 months and 6 months after surgery. The pain will be assessed by the visual analogue scale (VAS) scores: an 11-point VAS score at rest (VASr) will be recorded (0 indicates no pain, 10 indicates the most severe pain imaginable, a higher score means worse pain)
The Oswestry Disability Index (ODI) Preoperatively and at 4 weeks, 6 weeks and 3 months, 6 months after surgery. Functional disability will be assessed by the Oswestry Disability Index. It includes 10 questions about pain and activities of daily living. Each item has five response categories from no pain related disability (0), to the worst possible pain disability (100). The ODI has been reported to be the most widely used and validated outcome measure in spinal surgery.
The total times that participants press patient-controlled analgesia button Within 48 hours after the operation The total times that participants press patient-controlled analgesia button including effective presses and ineffective presses.
Patient Satisfaction Score (PSS) At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 4 weeks, 6 weeks, 3 months and 6 months after surgery The Patient Satisfaction Score (PSS): 0 for unsatisfactory, and 10 for very satisfied
Ramsay Sedation Scale (RSS) At 2 hours, 4 hours, 8 hours, 24 hours, 48 hours after surgery The Ramsay Sedation Scale (RSS): A 6-point scale will be used to assess sedation levels, with 1 indicating agitated, anxious; 2, cooperative; 3, only responds to commands; 4, strong response to glabellar tapping or noisy stimulants; 5, weak response to glabellar tapping or noisy stimulants; 6, no response.
Patient Scar Assessment and the Observer Scar Assessment Scale (POSAS) At 6 months postoperatively The Patient and Observer Scar Assessment Scale includes subjective symptoms of pain and pruritus and consists of 2 numerical scales: The Patient Scar Assessment Scale and the Observer Scar Assessment Scale. It assesses vascularity, pigmentation, thickness, relief, pliability, surface area and overall opinion for a scar on a score of 1 (normal skin) to 10 (worst scar imaginable). and it incorporates patient assessments of pain, itching, color, stiffness, thickness, relief and overall opinion. Participants were asked to rate the severity of their scar compared to normal skin. The overall opinion scale score ranged from 1 (normal skin) to 10 (very different from normal skin)
Trial Locations
- Locations (1)
Beijing Tiantan Hospital
🇨🇳Beijing, Beijing, China