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A prospective randomized comparative study of postoperative pain control using an epidural catheter in patients undergoing posterior lumbar interbody fusion

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Abstract

Purpose

To assess the efficacy of continuous epidural infusion analgesia (ED) with 0.2 % Ropivacaine versus IV PCA (Fentanyl) in spinal fusion surgery patients.

Method

A prospective randomized comparative clinical trial. Patients were randomized into one of two groups—the epidural group (ED-51 patients) and the IV PCA group (IV-43 patients). The epidural catheter tip was placed one level cephalad to the level of the PLIF in patients in the ED group. Patients were assessed by determining the pain score, cumulative opioid requirement, adverse effects, and satisfaction.

Results

Pain score comparisons between the ED group and the IV group, respectively, were as follows: immediate postoperative status: 2.1 ± 1.5 vs. 7.2 ± 2.1, p = 0.01; postoperative day 1: 2.3 ± 1.9 vs. 6.8 ± 2.3, p = 0.02; postoperative day 2: 1.9 ± 1.8 vs. 5.4 ± 2.1, p = 0.02; postoperative day 3: 1.5 ± 1.6 vs. 3.9 ± 1.9, p = 0.03; postoperative day 4: 3.8 ± 2.1 vs. 3.1 ± 1.9, p = 0.4. Lower levels of opioids were required in the ED group, and fewer opioid-related complications developed in the patients in this group. Complications related to the use of epidural catheters were comparable between the two groups. Patient satisfaction with postoperative pain control was higher in the ED group.

Conclusion

In comparison with the use of IV PCA only, continuous epidural infusion of Ropivacaine resulted in lower pain scores and opioid consumption and higher patient satisfaction levels after posterior lumbar interbody fusion.

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References

  1. Weinstein JN, Tosteson TD, Lurie JD, Tosteson AN, Blood E, Hanscom B, Herkowitz H, Cammisa F, Albert T, Boden SD (2008) Surgical versus nonsurgical therapy for lumbar spinal stenosis. N Engl J Med 358:794–810

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Tosteson AN, Lurie JD, Tosteson TD, Skinner JS, Herkowitz H, Albert T, Boden SD, Bridwell K, Longley M, Andersson GB (2008) Surgical treatment of spinal stenosis with and without degenerative spondylolisthesis: cost-effectiveness after 2 years. Ann Intern Med 149:845–853

    Article  PubMed  PubMed Central  Google Scholar 

  3. Ross DA, Drasner K, Weinstein PR, Flaherty JF, Barbaro NM (1991) Use of intrathecally administered morphine in the treatment of postoperative pain after lumbar spinal surgery: a prospective, double-blind, placebo-controlled study. Neurosurgery 28:700–704

    Article  CAS  PubMed  Google Scholar 

  4. Guilfoyle MR, Mannion RJ, Mitchell P, Thomson S (2012) Epidural fentanyl for postoperative analgesia after lumbar canal decompression: a randomized controlled trial. Spine J 12:646–651. doi:10.1016/j.spinee.2012.07.007

    Article  PubMed  Google Scholar 

  5. Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, Guberti A, Massari L (2004) The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg 98:166–172 ((table of contents))

    Article  CAS  PubMed  Google Scholar 

  6. Joshi GP, McCarroll SM, O’Rourke K (1995) Postoperative analgesia after lumbar laminectomy: epidural fentanyl infusion versus patient-controlled intravenous morphine. Anesth Analg 80:511–514

    CAS  PubMed  Google Scholar 

  7. Huang AR, Mallet L (2012) Prescribing opioids in older people. Maturitas. doi:10.1016/j.maturitas.2012.11.002

    PubMed  Google Scholar 

  8. Schenk MR, Putzier M, Kugler B, Tohtz S, Voigt K, Schink T, Kox WJ, Spies C, Volk T (2006) Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia. Anesth Analg 103:1311–1317. doi:10.1213/01.ane/0000247966.49492.72

    Article  PubMed  Google Scholar 

  9. Maheshwari AV, Blum YC, Shekhar L, Ranawat AS, Ranawat CS (2009) Multimodal pain management after total hip and knee arthroplasty at the Ranawat Orthopaedic Center. Clin Orthop Relat Res 467:1418–1423. doi:10.1007/s11999-009-0728-7

    Article  PubMed  PubMed Central  Google Scholar 

  10. Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan JA Jr, Wu CL (2003) Efficacy of postoperative epidural analgesia: a meta-analysis. JAMA J Am Med Assoc 290:2455–2463. doi:10.1001/jama.290.18.2455

    Article  CAS  Google Scholar 

  11. Horlocker TT (1998) Peripheral nerve blocks–regional anesthesia for the new millennium. Reg Anesth Pain Med 23:237–240

    Article  CAS  PubMed  Google Scholar 

  12. Chan JH, Heilpern GN, Packham I, Trehan RK, Marsh GD, Knibb AA (2006) A prospective randomized double-blind trial of the use of intrathecal fentanyl in patients undergoing lumbar spinal surgery. Spine 31:2529–2533. doi:10.1097/01.brs.0000241135.79983.52

    Article  PubMed  Google Scholar 

  13. Indelli PF, Grant SA, Nielsen K, Vail TP (2005) Regional anesthesia in hip surgery. Clin Orthop Relat Res 441:250–255

    Article  PubMed  Google Scholar 

  14. Cassady JF Jr, Lederhaas G, Cancel DD, Cummings RJ, Loveless EA (2000) A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med 25:246–253

    CAS  PubMed  Google Scholar 

  15. Zink W, Seif C, Bohl JR, Hacke N, Braun PM, Sinner B, Martin E, Fink RH, Graf BM (2003) The acute myotoxic effects of bupivacaine and ropivacaine after continuous peripheral nerve blockades. Anesth Analg 97:1173–1179 (table of contents)

    Article  CAS  PubMed  Google Scholar 

  16. Blumenthal S, Min K, Nadig M, Borgeat A (2005) Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology 102:175–180

    Article  CAS  PubMed  Google Scholar 

  17. Whiteside JB, Wildsmith JA (2001) Developments in local anaesthetic drugs. Br J Anaesth 87:27–35

    Article  CAS  PubMed  Google Scholar 

  18. Kanai A, Nakahara R, Okamoto H, Hoka S (2003) Postoperative analgesia using continuous lumbar epidural infusion of ropivacaine in comparison with bupivacaine. Masui 52:832–839

    PubMed  Google Scholar 

  19. Lee BB, Ngan Kee WD, Lau WM, Wong AS (2002) Epidural infusions for labor analgesia: a comparison of 0.2 % ropivacaine, 0.1 % ropivacaine, and 0.1 % ropivacaine with fentanyl. Reg Anesth Pain Med 27:31–36

    Article  CAS  PubMed  Google Scholar 

  20. Guinard JP, Carpenter RL, Owens BD, Nadir B (1991) Comparison between ropivacaine and bupivacaine after subcutaneous injection in pigs: cutaneous blood flow and surgical bleeding. Reg Anesth 16:268–271

    CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Korea University, College of Medicine, Anam Hospital, 126-1 Anamdong 5ga, Seongbukgu, Seoul, Korea

    Si Young Park, Soon Hyuck Lee, Seung Woo Suh & Jeong Lae Kim

  2. Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA

    Howard S. An

  3. Department of Anesthesiology, Korea University, College of Medicine, Seoul, Korea

    Seung Joo Yoon

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  1. Si Young Park
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  2. Howard S. An
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  3. Soon Hyuck Lee
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Correspondence to Si Young Park.

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Park, S.Y., An, H.S., Lee, S.H. et al. A prospective randomized comparative study of postoperative pain control using an epidural catheter in patients undergoing posterior lumbar interbody fusion. Eur Spine J 25, 1601–1607 (2016). https://doi.org/10.1007/s00586-016-4385-8

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  • DOI: https://doi.org/10.1007/s00586-016-4385-8

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