In a poster presentation at BritSpine (2–4 April, Warwick, UK) Douglas Wardlaw, consultant orthopaedic and spinal surgeon (retired), NHS Grampian, Scotland, and others reported that the use of intraoperative epidural analgesia with local anaesthetic is a safe and effective approach to managing postoperative pain following spinal surgery.
Wardlaw et al note that data for epidural analgesia show that it is an effective way of relieving postoperative pain following surgical procedures on the lumbar spine. They add: “As the epidural space is readily accessible during spinal surgery, epidural analgesia becomes an attractive adjuvant for postoperative analgesia. There have been some reports in the literature in administration of epidural opiates for relief of postoperative pain following spinal surgery. However, they are associated with complications such as nausea, urinary retention, respiratory depression, and pruritis; also, patients need additional postoperative monitoring for 24 hours.” Therefore, the authors reviewed the use epidural analgesia with a single epidural injection of local anaesthesia in patients undergoing spinal surgery.
In the study, 37 patients were enrolled; but eight had incomplete data recordings, leaving 29 consecutive patients undergoing spinal surgery were randomised to receive 10ml of 0.5% bupivacine hydrochloride (15 patients; treatment group) or 10ml of 0.9% saline (14 patients; control group). Wardlaw et al assessed the Visual Analogue Scale (VAS), the Present Pain Intensity rating, patient-controlled analgesia morphine requirements, the period required for independent mobilisation, and hospital stay to evaluate the effects of epidural analgesia (with local anaesthetic) as a method of adjuvant analgesia. They observed patients preoperatively and at two, six, and 24 hours postoperatively, and took steps to ensure that the anaesthetic protocol and postoperative pain management was standardised for all patients so confounding factors would be minimised.
The authors report that the treatment group needed significantly less systemic opiates during the first 24 hour postoperative period compared with the control group (p<0.005) for the comparison, and the treatment group also had a significantly lower VAS score (p<0.05) and a significant reduction in the six-hour ratings of Present Pain Intensity (p=0.05).
However, there was no difference between groups in the length of postoperative hospital stay or in the need for additional analgesia. No complications were observed in either group. At this dose of anaesthetic, patients had good pain relief with no effect on muscle function. After a two-hour stay in the recovery room, no close monitoring is required.
Wardlaw et al conclude: “Epidural analgesia with a local anaesthetic is a safe, simple and effective way to control postoperative pain following spinal surgery on the lumbar spine.”
The study was also published as abstract in the European Spine Journal.