Preemptive Co-infiltration of Dexamethasone Palmitate With Ropivacaine for Postoperative Pain in Major Spinal Surgery

The cumulative consumption of sufentanil via PCA pump between 24 hours and 48 hours postoperatively.

Patients will use PCA device for pain management within the the first 48 hours after surgery. When the patients feel pain, the PCA button will be pressed. When the patients feel no pain, the PCA button will not be pressed. The PCA pump will provide a bolus of 2μg sufentanil with a 10 minutes lock-out time, and the maximum dose of sufentanil will be limited to 8μg/h.

Time frame: Between 24 hours and 48 hours after spinal surgery

Number of patients without PCA press button

Patients will use PCA device for postoperative analgesia. When the patients feel pain, the PCA button will be pressed. When the patients feel no pain, the PCA button will not be pressed. The PCA pump will provide a bolus of 2μg sufentanil with a 10 minutes lock-out time, and the maximum dose of sufentanil will be limited to 8μg/h.

Time frame: Within 48 hours after spinal surgery

The time of first PCA demand

The first time that the participants press PCA button.

Time frame: Within 48 hours after spinal surgery

The total number of PCA presses including both valid and invalid presses

The total number that participants press PCA button including valid and invalid presses

Time frame: Within 48 hours after spinal surgery

Postoperative visual analogue scale (VAS) score during movement(VASm)

The pain will be assessed by VAS scores during movement (0 indicates no pain, 10 indicates the most severe pain imaginable, a higher score means worse pain)

Time frame: At 2 hours, 4 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 3 weeks, 1 month and 3 months postoperatively

Postoperative VAS score at rest(VASr)

The pain will be assessed by VAS scores at rest (0 indicates no pain, 10 indicates the most severe pain imaginable, a higher score means worse pain)

Time frame: At 2 hours, 4 hours, 24 hours, 48 hours, 72 hours, 1 week, 2 weeks, 3 weeks, 1 month and 3 months postoperatively

Total consumption of Tylenol as supplementary analgesia

During the initial postoperative 48 hours, when VAS\>4 (either VASm or VASr) after pressing button four times with PCA pump for pain relief, patients will be treated for supplementary analgesia with oral Tylenol (Mallinckrodt Inc.), a combination of 5mg of oxycodone hydrochloride and 325mg paracetamol per tablet at a minimum interval of 6 hours. After the initial postoperative 48 hours, patients will be allowed to take oral Tylenol as needed (dose as previously described), until the end of the study (3-months follow-up).

Time frame: Four separate postoperative periods ( 0- postoperative 48 hours, postoperative 48 hours-postoperative 2 weeks, postoperative 2 weeks-postoperative 1 month, and postoperative 1 month-postoperative 3 months)

Patient Satisfaction Score (PSS) with pain relief

4 scales; never, sometimes, usually or always

Time frame: At 48 hours, 72 hours, 1 week, 2 weeks, 3 weeks 1 month and 3 months postoperatively

Postoperative nausea and vomiting (PONV) score

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.

Time frame: At 2 hours, 4 hours, 24 hours, 48 hours and 72 hours postoperatively

Ramsay Sedation Scale (RSS)

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.

Time frame: At 2 hours, 4 hours, 24 hours, 48 hours and 72 hours postoperatively

Patient Scar Assessment and the Observer Scar Assessment Scale (POSAS)

The POSAS consists of an Observer and a Patient Scale and includes a comprehensive list of items, based on clinically relevant scar characteristics. The observer scores six items: vascularization, pigmentation, thickness, surface roughness, pliability, and surface area. The patient scores six items: pain, pruritus, color, thickness, relief, and pliability. All included items are scored on the same polytomous 10-point scale, in which a score of 1 is given when the scar characteristic is comparable to normal skin and a score of 10 reflects the worst imaginable scar. All items are summed to give a total scar score, and therefore, a higher score represents a poorer scar quality.

Time frame: At 2 weeks, 1 month and 3 months postoperatively

Rate of steroid-related side effects and complications

Steroid-related side effects (hyperglycemia, gastrointestinal bleeding, gastritis, etc.) or complications including any cardiac, respiratory, renal, neurologic, or infection complications occured during the hospitalization

Time frame: Through the whole follow-up, an average of 3 months

Readmission rate within 3 months after spine surgery;

Patients readmitted within 3 months after spine surgery

Time frame: Through the whole follow-up, within 3 months after spine surgery

Length of Postoperative Anesthesia Care Unit (PACU) stay

Time from arrival at PACU after tracheal extubation to transfer from PACU to the surgical ward (modified Aldrete score ≥9).

Time frame: Approximately 30 minutes to 2 hours after surgery

Duration of hospitalization after surgery

Duration of hospitalization after surgery (time required from the end of surgery to discharge from the hospital).

Time frame: Approximately 1-2 weeks after surgery

Total consumption of remifentanil during surgery

Total remifentanil dosages during surgery

Time frame: During surgery

Total consumption of loxoprofen

Pain management will be provided via the sufentanil PCA device for the first 48 hours following surgery. After that, patients will switch to taking oral loxoprofen 60 mg at a minimum interval of 8 hours and a maximum 180mg per day as needed until discharge.

Time frame: From postoperative 48 hours to approximately 1-2 weeks after surgery