Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics

Abstract

This prospective study aimed to compare the efficacy of epidural (EDA) versus intravenous (PCA) application of analgesics after lumbar fusion. Fifty-two patients scheduled for elective posterior instrumented lumbar fusion were randomized into two groups. EDA patients received an epidural catheter intraoperatively, and administration of ropivacain and sulfentanil was started after a normal postoperative wake-up test in the recovery room area. PCA patients received intravenous opioids in the post-operative period. Differences between EDA and PCA groups in terms of patient satisfaction with respect to pain relief were not significant. Nevertheless, EDA patients reported less pain on the third day after surgery. There were significantly more side effects in the EDA group, including complete reversible loss of sensory function and motor weakness. There were no major side effects, such as infection or persisting neurological deficits, in either group. The routine use of epidural anesthesia for lumbar spine surgery has too many risks and offers very little advantage over PCA.

Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries

“…A total of 136 studies were identified from our electronic database searching and manual searching, remaining 9 studies qualified for our meta-analysis [12,27,[39][40][41][42][43][44][45]. Briefly, we excluded studies for duplicates (n = 1), unrequired article types (letters, reviews, non-human studies, unrelated to research topics and meta-analysis; n = 54).…”

Colloid versus crystalloid soaked gelfoam with morphine for postoperative pain relief after lumbar laminectomy

“…After spine surgery epidural catheters are difficult to manage and maintain. In addition, there is always a concern of infection, restricting its widespread application [3]. Other investigators have attempted to prolong the duration of analgesic action by morphine-adon L compound, Oxiplex/ SP gel-morphine [10] and Vaseline-Sterile-Oil-Morphine [11] and many of these techniques lack wider applicability.…”

“…Epidural catheters are difficult to manage and maintain after spine surgery. In addition, there is always a concern of infection, restricting its widespread application [3]. The easy access to epidural space during laminectomy surgery was utilized safely for applying morphine directly over the exposed dura mater in earlier studies but has limited application due to short duration of action (3-24 h) [4].…”

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

“…Others found that differences in pain relief occurred only after 12 hours, even days after surgery [35,37]. Some authors found that due to the frequent side-effects the epidural route could not be recommended as first line treatment for postoperative analgesia after spine surgery [24, 35,47], while more patients suffered paresthesia with placement of the catheter [25][26][27]. Failure of the epidural modality, need for temporarily or permanent discontinuation of epidural treatment and/or catheter loss while costing significantly more than systemic analgesia were additional reasons for less enthousiasm in certain studies [20,29,34].…”

“…A limited duration of analgesia should be expected when using substances in single dose application. Others found that differences in pain relief occurred only after 12 hours, even days after surgery [35,37]. Some authors found that due to the frequent side-effects the epidural route could not be recommended as first line treatment for postoperative analgesia after spine surgery [24, 35,47], while more patients suffered paresthesia with placement of the catheter [25][26][27].…”