Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery.
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.
Gottschalk
André
A
Department of Anesthesiology, University Hospital Eppendorf, Hamburg, Germany. gottschalk.andre@gmx.de
Freitag
Marc
M
Tank
Sascha
S
Burmeister
Marc-Alexander
MA
Kreil
Sonja
S
Kothe
Ralph
R
Hansen-Algenstedt
Nils
N
Weisner
Lothar
L
Staude
Hans-Jürgen
HJ
Standl
Thomas
T
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*
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077212:Ropivacaine