Effect of Multimodal Cocktail Injection in Postoperative Analgesia after Cervical Laminoplasty: A Prospective Randomized Controlled Trial

Abstract

Introduction: The analgesic effect and safety of multimodal cocktail injection after cervical laminoplasty were examined in a prospective randomized controlled trial.

Methods: A total of 50 patients, who underwent cervical laminoplasty, were randomized into two groups. The cocktail group (25 patients) received intraoperative wound infiltration of local anesthetics, epinephrine, prednisolone, and nonsteroidal anti-inflammatory drugs at the end of surgery. The noncocktail group (25 patients) received only intraoperative wound infiltration of levobupivacaine. The outcome measures were amount of postoperative analgesic usage within 24 hours and visual analogue scale (VAS) for pain within 7 days and time to first analgesic demand.

Results: Wound pain VAS was low in the cocktail group at all measurement points 6 hours after surgery, and significantly lower in the cocktail group 1, 3, 5, and 6 days after surgery (p = 0.01, 0.019, 0.024, 0.009). The total amount of postoperative analgesic usage in the first 24 hours was significantly lower in the cocktail group (p = 0.04). No complications, such as postoperative muscle paralysis or wound infection, were observed.

Conclusions: Multimodal cocktail injection significantly reduced VAS for wound pain within 6 days and analgesic usage within 24 hours in postoperative analgesia with no increased side effects after cervical laminoplasty.