Postoperative Analgesia After Major Spine Surgery: Patient-Controlled Epidural Analgesia Versus Patient-Controlled Intravenous Analgesia

Schenk, Michael; Putzier, Michael; Kügler, Bjoern; Tohtz, Stephan; Voigt, Kristina; Schink, Tania; Kox, Wolfgang J.; Spies, Claudia; Volk, Thomas

doi:10.1213/01.ane/0000247966.49492.72

Cited by 86 publications

(63 citation statements)

References 16 publications

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“…These data are in line with published data of patients with posterior spinal surgery in the noninfectious setting, which demonstrated reduced time to reach turning capacities in bed in patients with epidural analgesia compared with patients with intravenous analgesia. 16 In regard to technical handling of epidural catheters, no complications in the form of disruption of the dura or violation of the spinal cord were observed when visually placing the catheter, which concurs with the literature and the consensus of a more feasible intraoperative catheter insertion compared with a preoperative catheter placement (Table 3). 7 Further, follow-up did not reveal any catheterassociated complications such as respiratory depression or neurological worsening, as has been previously described.…”

Section: Discussionsupporting

confidence: 86%

Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery

Geßler¹,

Mutlak

Tizi³

et al. 2016

SPI

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OBJECTIVE The value of postoperative epidural analgesia after major spinal surgery is well established. Thus far, the use of patient-controlled epidural analgesia (PCEA) has been denied to patients undergoing debridement and instrumentation in spondylodiscitis, with the risk of increased postoperative pain resulting in prolonged recovery. The value of PCEA with special regard to infectious complications remains to be clarified. The present study examined the value of postoperative PCEA in comparison with intravenous analgesia in patients with spondylodiscitis undergoing posterior spinal surgery. METHODS Thirty-two patients treated surgically for spondylodiscitis of the thoracic and lumbar spine were prospectively included in a database and retrospectively reviewed for this study. Postoperative antibiotic treatment, functional capacity, pain levels, side effects, and complications were documented. Sixteen patients were given patient-demanded intravenous analgesia (PIA) followed by 16 patients assigned to PCEA. If PCEA was applied, the insertion of an epidural catheter was performed under the direct visual guidance of the surgeon at the end of the surgery. RESULTS Three patients intended for PCEA treatment were excluded due to predefined exclusion criteria. Postoperative pain was significantly lower in the PCEA group during the first 48 hours after surgery (p = 0.03). As determined by the trunk control test conducted at 8 (p < 0.001), 24 (p = 0.004), 48 (p = 0.015), 72 (p = 0.0031), and 96 hours (p < 0.001), patients in the PCEA treatment group displayed significantly increased mobilization capacity compared with those of the PIA group. Time until normal accomplishment of all mobilization maneuvers was reduced in the PCEA group compared with that in the PIA group (p = 0.04). No differences in complication rates were observed between the 2 groups (p = 0.52). CONCLUSIONS PCEA may reduce postoperative pain and lead to earlier achievement of functional capacity at a low complication rate in patients with surgically treated lumbar and thoracic spondylodiscitis.

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Section: Discussionsupporting

confidence: 86%

Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery

Geßler¹,

Mutlak

Tizi³

et al. 2016

SPI

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“…EA had not been used, and mean opioid doses were low compared with those in trials using patient-controlled Iv analgesia that demonstrated an average consumption of 150 mg oral morphine equivalents within the first 24 hours. 17,18 Even though open reduction of the calcaneus-the procedure with the highest pain score in this study-was associated with a comparatively high opioid administration of 40 mg, another trial demonstrated that patients used on average 167 mg Iv morphine via patientcontrolled anesthesia (approximately 500 mg oral morphine equivalents) during the first 24 h. 19 EA and peripheral nerve blocks are known to reduce postoperative pain intensity. 20 For many procedures, especially those that are known to cause severe postoperative pain, guidelines from many countries recommend the use of rA for postoperative pain control.…”

Section: Discussionmentioning

confidence: 69%

Pain Intensity on the First Day after Surgery

et al. 2013

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Background: Severe pain after surgery remains a major problem, occurring in 20-40% of patients. Despite numerous published studies, the degree of pain following many types of surgery in everyday clinical practice is unknown. To improve postoperative pain therapy and develop procedurespecific, optimized pain-treatment protocols, types of surgery that may result in severe postoperative pain in everyday practice must first be identified. Methods: This study considered 115,775 patients from 578 surgical wards in 105 German hospitals. A total of 70,764 patients met the inclusion criteria. On the first postoperative day, patients were asked to rate their worst pain intensity since surgery (numeric rating scale, 0-10). All surgical procedures were assigned to 529 well-defined groups. When a group contained fewer than 20 patients, the data were excluded from analysis. Finally, 50,523 patients from 179 surgical groups were compared. Results: The 40 procedures with the highest pain scores (median numeric rating scale, 6-7) included 22 orthopedic/trauma procedures on the extremities. Patients reported high pain scores after many "minor" surgical procedures, including appendectomy, cholecystectomy, hemorrhoidectomy, and tonsillectomy, which ranked among the 25 procedures with highest pain intensities. A number of "major"

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“…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).…”

Section: Included Studiesmentioning

confidence: 99%

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

Wang

et al. 2015

Arch Orthop Trauma Surg

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Postoperative Analgesia After Major Spine Surgery: Patient-Controlled Epidural Analgesia Versus Patient-Controlled Intravenous Analgesia

Abstract: We conclude that PCEA with ropivacaine and sufentanil, using intraoperatively placed epidural catheters, provides superior analgesia and higher patient satisfaction when compared with PCIA after spinal fusion surgery.

Cited by 86 publications

References 16 publications

Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery

Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery

Pain Intensity on the First Day after Surgery

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

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