Quality of Postoperative Pain Using an Intraoperatively Placed Epidural Catheter after Major Lumbar Spinal Surgery

Gottschalk, André; Freitag, M.; Tank, Sascha; Burmeister, Marc-Alexander; Kreil, Sonja; Kothe, Ralph; Hansen-Algenstedt, Nils; Weisner, Lothar; Staude, Hans-Jürgen; Standl, Thomas

doi:10.1097/00000542-200407000-00027

Cited by 95 publications

(73 citation statements)

References 11 publications

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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: 67%

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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Section: Discussionmentioning

confidence: 67%

Pain Intensity on the First Day after Surgery

et al. 2013

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“…This includes multilevel instrumentation which is often associated with severe pain and consumption of large amounts of opioids thereby hindering postoperative mobilization and rehabilitation [3,4]. Also, patients undergoing major spine surgery often suffer from pre-operative chronic pain, further challenging postoperative pain treatment [5,6].…”

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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“…Before closure, an epidural catheter for postoperative pain management is inserted [17]. Autogenous bone from local bone resection is placed as posterior fusion material.…”

Section: Surgical Proceduresmentioning

confidence: 99%