title: Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery.
abstract: BACKGROUND
  Major spinal surgery is associated with high postoperative pain scores and opioid requirement. The aim of the current prospective, randomized, placebo-controlled, double-blind study was to assess the reduction of opioid requirement and pain scores using an intraoperatively placed epidural catheter with infusion of 0.1% ropivacaine during the postoperative period.
  
  
  METHODS
  Thirty patients undergoing major lumbar spinal surgery from a dorsal approach were included in this study. Before wound closure, the orthopedic surgeon inserted an epidural catheter. Postoperatively, patients were randomly assigned to receive an infusion of 12 ml/h ropivacaine, 0.1% (group R), or 12 ml/h saline (group N) after an initial bolus of 10 ml of the respective study solution. Additional pain relief was provided using an intravenous patient-controlled analgesia pump with the opioid piritramide. Patients were assessed with respect to pain scores (visual analog scale of 0-100), cumulative opioid requirement, side effects, and satisfaction with pain management.
  
  
  RESULTS
  : Demographic data, duration of surgery, and type of surgery were comparable between groups. Pain scores were assessed as follows (group R vs. group N: 6 h: 24 +/-20 vs. 51 +/- 20, P = 0.002; 24 h: 33 +/- 19 vs. 53 +/- 27, P = 0.04; 48 h: 21 +/-17 vs. 40 +/- 26, P = 0.04; 72 h: 14 +/- 13 vs. 38 +/- 25, P = 0.02). The cumulative piritramide requirement after 72 h was 97 +/- 23 mg in group R and 157 +/-72 mg in group N (P = 0.03). The incidence of side effects was comparable between groups, and patient satisfaction was always higher in group R (P < 0.05).
  
  
  CONCLUSIONS
  Continuous epidural infusion of 0.1% ropivacaine results in lower pain scores and opioid consumption and higher patient satisfaction when compared with placebo. Application of ropivacaine using an epidural catheter seems to be a highly effective treatment for postoperative pain after major lumbar spinal surgery.
authors.affiliation: Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany. gottschalk.andre@gmx.de
authors.forename: André
authors.initials: A
authors.lastname: Gottschalk
authors.forename: Marc
authors.initials: M
authors.lastname: Freitag
authors.forename: Sascha
authors.initials: S
authors.lastname: Tank
authors.forename: Marc-Alexander
authors.initials: MA
authors.lastname: Burmeister
authors.forename: Sonja
authors.initials: S
authors.lastname: Kreil
authors.forename: Ralph
authors.initials: R
authors.lastname: Kothe
authors.forename: Nils
authors.initials: N
authors.lastname: Hansen-Algenstedt
authors.forename: Lothar
authors.initials: L
authors.lastname: Weisner
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Staude
authors.forename: Thomas
authors.initials: T
authors.lastname: Standl
mesh_terms: D000328:Adult; D000577:Amides / Q000097:blood / Q000627:therapeutic use; D015360:Analgesia, Epidural / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000097:blood / Q000627:therapeutic use; D004311:Double-Blind Method; D006801:Humans; D008875:Middle Aged; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D010892:Pirinitramide / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000077212:Ropivacaine; D013131:Spine / Q000601:surgery*
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077212:Ropivacaine