title: Postoperative patient-controlled epidural analgesia in patients with spondylodiscitis and posterior spinal fusion surgery.
abstract: OBJECTIVE The value of postoperative epidural analgesia after major spinal surgery is well established. Thus far, the use of patient-controlled epidural analgesia (PCEA) has been denied to patients undergoing debridement and instrumentation in spondylodiscitis, with the risk of increased postoperative pain resulting in prolonged recovery. The value of PCEA with special regard to infectious complications remains to be clarified. The present study examined the value of postoperative PCEA in comparison with intravenous analgesia in patients with spondylodiscitis undergoing posterior spinal surgery. METHODS Thirty-two patients treated surgically for spondylodiscitis of the thoracic and lumbar spine were prospectively included in a database and retrospectively reviewed for this study. Postoperative antibiotic treatment, functional capacity, pain levels, side effects, and complications were documented. Sixteen patients were given patient-demanded intravenous analgesia (PIA) followed by 16 patients assigned to PCEA. If PCEA was applied, the insertion of an epidural catheter was performed under the direct visual guidance of the surgeon at the end of the surgery. RESULTS Three patients intended for PCEA treatment were excluded due to predefined exclusion criteria. Postoperative pain was significantly lower in the PCEA group during the first 48 hours after surgery (p = 0.03). As determined by the trunk control test conducted at 8 (p < 0.001), 24 (p = 0.004), 48 (p = 0.015), 72 (p = 0.0031), and 96 hours (p < 0.001), patients in the PCEA treatment group displayed significantly increased mobilization capacity compared with those of the PIA group. Time until normal accomplishment of all mobilization maneuvers was reduced in the PCEA group compared with that in the PIA group (p = 0.04). No differences in complication rates were observed between the 2 groups (p = 0.52). CONCLUSIONS PCEA may reduce postoperative pain and lead to earlier achievement of functional capacity at a low complication rate in patients with surgically treated lumbar and thoracic spondylodiscitis.
authors: Departments of 1 Neurosurgery and.
authors: Florian
authors: F
authors: Gessler
authors: Departments of 1 Neurosurgery and.|Anesthesia, Intensive Care Medicine, and Pain Therapy, University Hospital Frankfurt, Goethe-University, Frankfurt, Germany.
authors: Haitham
authors: H
authors: Mutlak
authors: Departments of 1 Neurosurgery and.
authors: Karima
authors: K
authors: Tizi
authors: Departments of 1 Neurosurgery and.
authors: Christian
authors: C
authors: Senft
authors: Departments of 1 Neurosurgery and.
authors: Matthias
authors: M
authors: Setzer
authors: Departments of 1 Neurosurgery and.
authors: Volker
authors: V
authors: Seifert
authors: Departments of 1 Neurosurgery and.
authors: Lutz
authors: L
authors: Weise
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D015299:Discitis / Q000601:surgery*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011184:Postoperative Period; D011446:Prospective Studies; D020127:Recovery of Function / Q000187:drug effects; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013904:Thoracic Vertebrae / Q000601:surgery; D016896:Treatment Outcome; D055815:Young Adult
keywords: ICU = intensive care unit; PCEA = patient-controlled epidural analgesia; PIA = patient-demanded intravenous analgesia; TCT = trunk control test; VAS = visual analog scale; epidural catheter; patient-controlled analgesia; postoperative infection; postoperative pain; spondylodiscitis