Zafer Orkun Toktaş1, Murat Konakçı2, Baran Yılmaz3, Murat Şakir Ekşi4, Tamer Aksoy5, Yasin Yener2, Orkun Koban6, Türker Kılıç3, Deniz Konya3. 1. Department of Neurosurgery, Bahçeşehir University Medical School, Çırağan Caddesi Osmanpaşa Mektebi Sokak No: 4-6, 34353, Istanbul, Turkey. drzafertoktas@gmail.com. 2. Department of Anesthesiology, Medikal Park Göztepe Hospital, Istanbul, Turkey. 3. Department of Neurosurgery, Bahçeşehir University Medical School, Çırağan Caddesi Osmanpaşa Mektebi Sokak No: 4-6, 34353, Istanbul, Turkey. 4. Department of Orthopedic Surgery-Spine Center, University of California, San Francisco, CA, USA. 5. Department of Anesthesiology, Bahçeşehir University Medical School, Istanbul, Turkey. 6. Department of Neurosurgery, Medikal Park Göztepe Hospital, Istanbul, Turkey.
Abstract
PURPOSE: Pain management following posterior spinal fusion surgeries is a challenging topic. Continuous epidural analgesia (CEA) technique has been invented to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies for effectiveness and safety of CEA are scarce in adult population. Our aim was to compare effectiveness and safety of patient-controlled CEA with conventional IV-PCA method in adult patient population. METHODS: Chart review of patients, scheduled for elective posterior spine fusion to treat spinal stenosis, degenerative disc disease, spondylolisthesis or spinal instability from May 2012 to March 2015, was performed. Patients with spinal infection, cancer, inflammatory disease, and ASA higher than class III, allergy to analgesic medications were excluded from the study. One hundred and nine patients were enrolled into the study. 80 out of 109 patients (40 in CEA group, 40 in IV-PCA group) were matched for age, gender, BMI, type of surgery, level of fusions. Visual Analog Scale scores (VAS) and Ramsay Sedation Scale (RSS) scores were evaluated following surgeries until post-operative 24th hour. RESULTS: There were 58 female patients (72.5 %). The mean age of the patients was 59.85 years (range 24-82 years). When VAS and RSS scores were compared between the groups, there were statistically significant differences between the groups in respect of VAS scores at every time point following surgery (lower in CEA group), whereas there was no significant difference between the groups in respect of RSS scores. More additional analgesia medication was needed in IV-PCA group (16 vs. 5 patients), which was significantly higher than CEA group (p = 0.029). CONCLUSIONS: Patient-controlled CEA method is as safe as IV-PCA method and is even more effective than that in controlling immediate post-operative pain in patients treated with posterior spinal fusion.
PURPOSE:Pain management following posterior spinal fusion surgeries is a challenging topic. Continuous epidural analgesia (CEA) technique has been invented to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies for effectiveness and safety of CEA are scarce in adult population. Our aim was to compare effectiveness and safety of patient-controlled CEA with conventional IV-PCA method in adult patient population. METHODS: Chart review of patients, scheduled for elective posterior spine fusion to treat spinal stenosis, degenerative disc disease, spondylolisthesis or spinal instability from May 2012 to March 2015, was performed. Patients with spinal infection, cancer, inflammatory disease, and ASA higher than class III, allergy to analgesic medications were excluded from the study. One hundred and nine patients were enrolled into the study. 80 out of 109 patients (40 in CEA group, 40 in IV-PCA group) were matched for age, gender, BMI, type of surgery, level of fusions. Visual Analog Scale scores (VAS) and Ramsay Sedation Scale (RSS) scores were evaluated following surgeries until post-operative 24th hour. RESULTS: There were 58 female patients (72.5 %). The mean age of the patients was 59.85 years (range 24-82 years). When VAS and RSS scores were compared between the groups, there were statistically significant differences between the groups in respect of VAS scores at every time point following surgery (lower in CEA group), whereas there was no significant difference between the groups in respect of RSS scores. More additional analgesia medication was needed in IV-PCA group (16 vs. 5 patients), which was significantly higher than CEA group (p = 0.029). CONCLUSIONS:Patient-controlled CEA method is as safe as IV-PCA method and is even more effective than that in controlling immediate post-operative pain in patients treated with posterior spinal fusion.
Entities:
Keywords:
Epidural analgesia; Post-operative pain control; Spinal fusion; Spinal surgery
Authors: Jerome F O'Hara; Jacek B Cywinski; John E Tetzlaff; Meng Xu; Alan R Gurd; Jack T Andrish Journal: Paediatr Anaesth Date: 2004-12 Impact factor: 2.556
Authors: Joshua W B Klatt; Jennie Mickelson; Man Hung; Simon Durcan; Chris Miller; John T Smith Journal: Spine (Phila Pa 1976) Date: 2013-09-01 Impact factor: 3.468