Postoperative Pain Control After Lumbar Spine Fusion
- 1 August 1997
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Spine
- Vol. 22 (16), 1892-1896
- https://doi.org/10.1097/00007632-199708150-00016
Abstract
A prospective, randomized, double-blind clinical trial. To compare the efficacy of postoperative continuous epidural analgesia versus patient-controlled analgesia in patients undergoing lumbar fusion. Controversy remains regarding the optimal strategy for postoperative pain control. Fifty-four patients were divided into two treatment groups. There was no difference between the groups with respect to age, levels fused, estimated blood loss, and use of spinal instrumentation. Patient-controlled analgesia or epidural analgesia was administered in a double-blind manner for a 3-day postoperative course. Each patient received both an epidural and a patient-controlled analgesia delivery system; 26 received the epidural active agent and 28 received patient-controlled analgesia. Postoperative time to liquids and solid food, ambulation, length of stay, and side effects was recorded. Pain was evaluated by a visual analog scale on postoperative days 1, 2, and 3. Results showed no difference between the groups with reference to diet, ambulation, length of stay, and visual analog scale scores. Minor side effects occurred in 71% of patients in both groups. No major complications occurred. Epidural catheter dislodgment occurred in 11% of patients. The total cost for epidural analgesia was approximately $550 more than that for patient-controlled analgesia for a 3-day postoperative course. These data suggest that there is no clinical advantage of epidural opiate/local anesthetic analgesia over systemic opiate by patient-controlled analgesia for spinal fusion patients. However, possible technical limitations (namely, the low dosage of bupivacaine and placement of the catheter tip) may have prevented adequate delivery of anesthetic to the involved segments. Although the incidence of side effects is similar, cost factors and a high incidence of epidural catheter dislodgment favor use of patient-controlled analgesia.Keywords
This publication has 17 references indexed in Scilit:
- Epidural Versus Patient-Controlled Analgesia with Morphine for Postoperative Pain After Orthopaedic Procedures in ChildrenJournal of Pediatric Orthopaedics, 1993
- Epidural opioids during laminectomy surgery for postoperative painJournal of Clinical Anesthesia, 1992
- Epidural and Intravenous Fentanyl Infusions Are Clinically Equivalent After Knee SurgeryAnesthesia & Analgesia, 1990
- The use of epidural morphine in patients undergoing total knee arthroplastyThe Journal of Arthroplasty, 1989
- Intraspinal Narcotic AnalgesiaSpine, 1989
- The Role of Intrathecal Opiates in the Management of Acute PainThe Clinical Journal of Pain, 1989
- Less pain with epidural morphine after knee arthroplastyActa Orthopaedica, 1989
- Increases in Intracranial Pressure from SuccinylcholineAnesthesiology, 1986
- The respiratory depression of epidural morphine.Anaesthesia, 1982
- Respiratory depression after intrathecal narcoticsAnaesthesia, 1980