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The objective of this prospective randomized double-blind study is to evaluate the added analgesic value of clonidine to the conventional local bupivacaine wound infiltration in posterior spine surgery.
Patients candidates to posterior spine surgery (Micro-discectomy, Lumbar laminectomy with or without fusion, cervical laminectomy) are asked to participate to this prospective study. After verification of inclusion and exclusion criteria, patients consenting to enter the study are randomly assigned to one of the following subgroups: 1-Pre-incisional wound infiltration with 20 mL of bupivacaine 0.25%. 2- Pre-incisional wound infiltration with 150 μg of clonidine with 20 mL of bupivacaine 0.25%. Demographic parameters, co-morbidities and other pre and per operative medical data are noted. In the post-operative period, patients received a standardized post-operative analgesic protocol (NSAI and paracetamol). Patients are asked to fill their pain diary using Visual Analog Scale (VAS) from day 0 till day 8 after surgery. Morphine rescue consumption is noted. Finally, the percentage of global subjective patient satisfaction regarding the post-operative wound pain is noted from 0 to 100.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Clonidine | Experimental | Clonidine 150μg added to bupivacaine in a local infiltration before wound incision |
|
| Bupivacaine | Active Comparator | Bupivacaine 0.25 % alone in the wound infiltration |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Bupivacaine | Drug | Local infiltration before wound incision with 20 ml of Bupivacaine 0.25 % alone |
|
| Measure | Description | Time Frame |
|---|---|---|
| Mean Area under curve | Pain is assessed on numeric rating scale (NRS) 8times/day during the first 3 days, 3times/day during the next 6days and one mean value during the night. The mean intensity of daily pain is obtained from the different values mentioned during day and night corrected by the duration covered by every value. It may vary from 0 to 10. | From the day of surgery till the 8th postoperative day (9 days and 8 nights=200h |
| Measure | Description | Time Frame |
|---|---|---|
| Area under Curve (AUC) of pain | The AUC during an interval (in days) is calculated by adding the different values of pain assessed during day and night multiplied by the duration (in hours) of sufferance from this amount of pain. The AUC during an interval is proportional to the mean intensity of pain suffered during the same interval. It is expressed in pain unit multiplied by hour | Calculated at Day 0-2, Day3-5, Day6-8 and all along the follow-up from Day0 till Day8 |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Joseph Maarrawi, MD, PhD | Laboratory of neurosciences, Faculty of medicine, St Joseph University of Beirut | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Hotel Dieu de france Hospital | Beirut | 16-6830 | Lebanon |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 28973650 | Derived | Abdel Hay J, Kobaiter-Maarrawi S, Tabet P, Moussa R, Rizk T, Nohra G, Okais N, Samaha E, Maarrawi J. Bupivacaine Field Block With Clonidine for Postoperative Pain Control in Posterior Spine Approaches: A Randomized Double-Blind Trial. Neurosurgery. 2018 Jun 1;82(6):790-798. doi: 10.1093/neuros/nyx313. |
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| ID | Term |
|---|---|
| D010149 | Pain, Postoperative |
| D000844 | Ankylosis |
| ID | Term |
|---|---|
| D011183 | Postoperative Complications |
| D010335 | Pathologic Processes |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D010146 | Pain |
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| ID | Term |
|---|---|
| D002045 | Bupivacaine |
| D003000 | Clonidine |
| ID | Term |
|---|---|
| D000813 | Anilides |
| D000577 | Amides |
| D009930 | Organic Chemicals |
| D000814 | Aniline Compounds |
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| Clonidine | Drug | Clonidine 150μg locally infiltrated with 20 ml of bupivacaine 0.25 % before wound incision |
|
| Daily rescue opiates consumption | The unit of rescue opiates consumption equals the administration of 5mg of morphine subcutaneously. The minimum interval between 2 rescue opiates consumption is 6 hours. Thus, the rescue opiates consumption may vary from 0 to 4/day. | From the day of surgery till the 3rd postoperative day |
| Global subjective patient satisfaction of post-operative wound pain control | It may vary from 0 that means a total dissatisfaction to 100% that means a complete satisfaction | Assessed at the end of follow-up on Day 8 |
| D009461 | Neurologic Manifestations |
| D012816 | Signs and Symptoms |
| D007592 | Joint Diseases |
| D009140 | Musculoskeletal Diseases |
| D000588 |
| Amines |
| D048288 | Imidazolines |
| D007093 | Imidazoles |
| D001393 | Azoles |
| D006573 | Heterocyclic Compounds, 1-Ring |
| D006571 | Heterocyclic Compounds |