title: A comparison of three types of postoperative pain control after posterior lumbar spinal surgery.
abstract: METHODS
  Retrospective, nonrandomized, comparative study.
  
  
  OBJECTIVE
  This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with three methods of pain control after posterior lumbar spinal surgery.
  
  
  BACKGROUND
  The use of opioids for postoperative pain control is common after spinal surgery; however, PONV is the most frequently encountered side effect, and it is yet to be overcome. The effectiveness of the use of an absorbable low-dose morphine-soaked microfibrillar collagen hemostatic sponge placed on the surface of the dural sac (epidural MMCHS) was compared to patient-controlled analgesia (PCA) and intermittent intramuscular bolus injection of meperidine for postoperative pain control after spine surgery.
  
  
  METHODS
  One hundred sixty-five patients who underwent short-segment posterior lumbar spinal decompression and fusion surgery between January 2007 and July 2007 in the orthopedic department of a medical center were enrolled. For postoperative pain control, 40 patients received epidural MMCHS, 48 patients received PCA, and 77 patients received meperidine injection. Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded at 4 hours postoperation and on postoperative days 1, 2, and 3.
  
  
  RESULTS
  The analgesic effect was enhanced significantly in both epidural MMCHS group and the PCA group as compared with the meperidine group on postoperative days 1 and 2 (P < 0.05). On postoperative days 1, 2, and 3, PONV was more severe in the PCA group than in the other two groups (P < 0.05). The side effects of epidural MMCHS were nausea (25%), pruritus (12.5%), vomiting (5%), and hypotension (2.5%).
  
  
  CONCLUSIONS
  A single low-dose epidural MMCHS is effective for postoperative pain control and minimizes the occurrence of PONV after posterior lumbar spinal surgery.
authors.affiliation: Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan.
authors.forename: Meng-Huang
authors.initials: MH
authors.lastname: Wu
authors.forename: Chung-Hang
authors.initials: CH
authors.lastname: Wong
authors.forename: Chi-Chien
authors.initials: CC
authors.lastname: Niu
authors.forename: Tsung-Ting
authors.initials: TT
authors.lastname: Tsai
authors.forename: Lih-Huei
authors.initials: LH
authors.lastname: Chen
authors.forename: Wen-Jer
authors.initials: WJ
authors.lastname: Chen
mesh_terms: D000368:Aged; D000698:Analgesia / Q000379:methods*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000379:methods; D016058:Analgesia, Patient-Controlled / Q000009:adverse effects / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008614:Meperidine / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D009325:Nausea / Q000209:etiology; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D011537:Pruritus / Q000209:etiology; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D008614:Meperidine