Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia.
BACKGROUND
Spinal fusion surgery causes severe postoperative pain, hampering reconvalescense. We investigated the efficacy of patient-controlled epidural analgesia (PCEA) in a prospective, double-blind, randomized, controlled comparison with patient-controlled IV analgesia (PCIA).


METHODS
After lumbar anterior-posterior fusion receiving an epidural catheter intraoperatively, 72 patients were given either PCEA (ropivacaine 0.125% and sufentanil 1.0 microg/mL at 14 mL/h; bolus: 5 mL; lockout time: 15 min) and IV placebo or PCIA (morphine 2.0 mg/mL; bolus: 3 mg; lockout time: 15 min) and epidural placebo. Pain levels (visual analog scale 0-10), functional capabilities (turning in bed, standing, and walking), analgesic consumption, and side effects were evaluated until 72 h after surgery.


RESULTS
Fourteen patients were excluded by predetermined criteria, leaving 58 patients for data analysis. Pain levels at rest and during mobilization were significantly lower in the PCEA when compared with that in the PCIA group throughout the study period (P < 0.0001 in all cases). Time until able to turn in bed was achieved earlier in the PCEA group (P < 0.05). Patients in the PCEA group were significantly more satisfied with pain therapy (P < 0.01).


CONCLUSIONS
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.
Schenk
Michael R
MR
Department of Anesthesiology and Intensive Care, Charité Universitätsmedizin Berlin, 10117 Berlin, Germany.
Putzier
Michael
M
Kügler
Bjoern
B
Tohtz
Stephan
S
Voigt
Kristina
K
Schink
Tania
T
Kox
Wolfgang J
WJ
Spies
Claudia
C
Volk
Thomas
T
D000328:Adult; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods* / Q000523:psychology; D016058:Analgesia, Patient-Controlled / Q000379:methods* / Q000523:psychology; D000771:Anesthesia, Intravenous / Q000379:methods* / Q000523:psychology; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement / Q000379:methods / Q000523:psychology; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology / Q000523:psychology; D011446:Prospective Studies; D013123:Spinal Fusion / Q000379:methods* / Q000523:psychology