Analgesic-soaked acellular dermal matrix for postoperative pain control after endoscopic spine surgery: a retrospective chart review

Objective: This study aimed to evaluate whether the intraoperative application of an acellular dermal matrix (ADM) patch soaked in ropivacaine and fentanyl over the dura mater during endoscopic spine surgery (ESS) reduces early postoperative pain and the need for rescue analgesics.Methods: This retrospective chart review included 426 patients who underwent ESS at a single institution. Patients were categorized into 2 groups: the ADM group (n=216), which received the analgesic-soaked patch, and the control group (n=210), which did not. Postoperative radicular and surgical-site pain were assessed using the numeric rating scale (0–10), and the proportion of patients requiring rescue analgesics was analyzed. Subgroup analyses were conducted in decompression-only cases to control for surgical invasiveness and patient-controlled analgesia (PCA) regimen.Results: The ADM group demonstrated significantly lower radicular pain scores at 6, 24, 48, and 72 hours postoperatively (all P<0.05) and reduced surgical-site pain at 48 hours. Fewer patients in the ADM group required rescue analgesics compared with the control group (13.0% vs. 27.1%, P<0.01). These findings remained consistent in the decompression-only subgroup (n=382) managed under a standardized PCA protocol.Conclusion: Intraoperative application of an analgesic-soaked ADM patch may serve as a simple and effective adjunct for early postoperative pain control after ESS, reducing radicular pain intensity and the need for rescue analgesics. This approach demonstrates potential for opioid-sparing within multimodal analgesia strategies, warranting confirmation through prospective randomized studies.