The management of pain after lumbar discectomy is a controversial subject. Effective postoperative analgesia is associated with lower rate of morbidity and results in shorter hospitalization, reducing overall cost. Wound infiltration widely used for the purpose is 0.25 or 0.5% bupivacaine and triamcinolone acetonide. We felt the need for a study to compare both in terms of their efficacy in our setup.

This is a prospective randomized, double-blind study comprising 60 patients of single-level prolapsed intervertebral disk, admitted in the Department of Neurosurgery at Vydehi Institute of Medical Sciences and Research Center, Bengaluru.

A total of 60 cases were taken and divided into two groups. Thirty cases in group A were infiltrated by a mixture of 50 mg of triamcinolone in 5 mL of normal saline. Thirty cases in group B were infiltrated by a mixture of 5 mL of 0.5% bupivacaine and 5 mL of normal saline.

The time interval between surgery and first dose of opiate analgesia was significantly higher in the bupivacaine group (5 h 31 min ± 1 h 14 min) compared with the triamcinolone group (3 h 20 min ± 40 min). The visual analog pain scale (VAS) scores at 2nd hour (group A 2.034 ± 0.84 vs group B 0.931 ± 0.64) and 4th hour (group A 4.104 ± 0.97 vs group B 2.314 ± 1.14) were also found to be significantly lower in the bupivacaine group compared with the triamcinolone group. However, there was no significant difference in the amount of total opiate analgesic consumption in 24 hours (258 vs 248 mg).

In the present study, the data suggest that intraoperative local infiltration of bupivacaine is safe and provides significant analgesia in the early postoperative period when compared with triamcinolone acetonide.

Based on the results of this study, we made departmental protocol to infiltrate all operative lumbar cases with bupivacaine.

Varadaraju DN, Patil SR, Kishan A, Gabbita A. Efficacy of Triamcinolone Acetonide vs Bupivacaine Local Infiltration for Early Postoperative Pain Control after Lumbar Disectomy: A Prospective Randomized Double-blind Study. J Spinal Surg 2016;3(3):79-82.