title: Patient-controlled epidural analgesia (PCEA) for postoperative pain control after lumbar spine surgery.
abstract: Spine surgery remains one of the most common procedures for patients with a wide variety of spine disorders. Postoperative pain after major spine surgery is moderate to severe. We retrospectively reviewed 245 medical records of adult patients undergoing major spine surgery who received either patient-controlled epidural analgesia based on local anesthetics and opioids or patient-controlled intravenous analgesia as postoperative pain management. Several outcomes were analyzed including pain intensity, opioid consumption, time to endotracheal extubation, the incidence of deep venous thrombosis, and length of stay in the hospital. We found that the use of patient-controlled epidural analgesia provided better postoperative analgesia [median (quartiles) verbal analog scale score of 4 (3, 5) vs. 5 (3, 6)] and decreased the amount of opioid consumption postoperatively [median of 0 mg (0, 3) vs. 35 mg (0, 150)] compared with patient-controlled intravenous analgesia. Also, a substantially higher number of patients in the patient-controlled intravenous group required opioids as rescue analgesia. Incidences of deep venous thrombosis, operating room extubation, and length of stay in the hospital were not associated with the analgesic technique. The results of this study suggest that the use of neuroaxial analgesia for the management of postoperative pain associated with major spine surgery may have some beneficial properties over intravenous analgesia. The use of a reduced amount of opioids by patients with epidural analgesia may be relevant because of potential fewer side effects mainly in elderly patients. Several limitations related to the retrospective nature of the study are described. Prospective randomized-controlled trials are needed to understand and elucidate the optimum regimen of postoperative pain management after major spine surgery.
authors.affiliation: Division of Anesthesiology and Critical Care Medicine, Cleveland Clinic, Cleveland, OH 44195, USA.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Cata
authors.forename: Edward M
authors.initials: EM
authors.lastname: Noguera
authors.forename: Emily
authors.initials: E
authors.lastname: Parke
authors.forename: Zeyd
authors.initials: Z
authors.lastname: Ebrahim
authors.forename: Andrea
authors.initials: A
authors.lastname: Kurz
authors.forename: Iain
authors.initials: I
authors.lastname: Kalfas
authors.forename: Edward
authors.initials: E
authors.lastname: Mascha
authors.forename: Ehab
authors.initials: E
authors.lastname: Farag
mesh_terms: D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000768:Anesthesia, General; D005260:Female; D006801:Humans; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000453:epidemiology
chemical_list: D000701:Analgesics, Opioid