Intraoperative epidural analgesia for pain relief after lumbar decompressive spine surgery: A systematic review and meta-analysis

Hermans, Sem M M; Lantinga-Zee, Aniek; Rijkers, Kim; Santbrink, Henk van; Hemert, Wouter L.W. van; Reinders, M.K.; Hoofwijk, D.; Kuijk, Sander M J van; Curfs, Inez

doi:10.1016/j.bas.2021.100306

Cited by 3 publications

(11 citation statements)

References 51 publications

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“…Epidural analgesia for major lumbar spine surgeries has been studied with mixed reviews 27,28 . This modality is possibly the most versatile one, as a variety of medications can be delivered in the epidural space by a single-injection or through the catheter 29–32 …”

Section: Enhanced Recovery After Surgery and Multimodal Analgesiamentioning

confidence: 99%

“…Medications used and studied for this purpose include long-acting LAs like ropivacaine, bupivacaine, and levobupivacaine; opioids like morphine and fentanyl steroids like methylprednisolone (Depo Medrol), prednisolone, triamcinolone, and dexamethasone and ketamine, either alone or in combinations 31–34 . All have shown favorable analgesic effects, except for ketamine.…”

Section: Enhanced Recovery After Surgery and Multimodal Analgesiamentioning

confidence: 99%

“…27,28 This modality is possibly the most versatile one, as a variety of medications can be delivered in the epidural space by a single-injection or through the catheter. [29][30][31][32] In addition to single-injection, catheters can also be used to deliver analgesics continuously or intermittently, as per patient demand or both. But to this date, studies have failed to establish the best regimen.…”

Section: Epidural Analgesicsmentioning

confidence: 99%

“…9 Medications used and studied for this purpose include longacting LAs like ropivacaine, bupivacaine, and levobupivacaine; opioids like morphine and fentanyl steroids like methylprednisolone (Depo Medrol), prednisolone, triamcinolone, and dexamethasone and ketamine, either alone or in combinations. [31][32][33][34] All have shown favorable analgesic effects, except for ketamine. One study compared an extended-release epidural morphine with preservative-free morphine and found equianalgesic outcomes but a better side effects profile with the first.…”

Section: Epidural Analgesicsmentioning

confidence: 99%

“…Epidural analgesia [27][28][29][30][31][32] Commonly used as a single-injection analgesia technique rather than anesthesia Both, local anesthetics and opioid, alone or in combination have been studied Benefits seen include better analgesia profile, reduced surgical stress response and reduced blood loss Side effects observed include NV, pruritus, infection and risk of motor block No best regimen has been established for continuous epidural analgesia Similar analgesic and side effects profile as adult population Whether single-injection or catheters, placement is preferably done by surgeon under direct vision due to unique challenges posed by these cases Paravertebral block (PVB) 44 Only one study used bilateral PVB catheters in opioiddependent patients undergoing lumbar fusion surgery…”

Section: Techniques Evidence Adult Evidence Pediatricmentioning

confidence: 99%

See 4 more Smart Citations

Perioperative pain management for spine surgeries

Sikachi,

Oliver,

Oliver

et al. 2023

International Anesthesiology Clinics

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Section: Enhanced Recovery After Surgery and Multimodal Analgesiamentioning

confidence: 99%

Section: Enhanced Recovery After Surgery and Multimodal Analgesiamentioning

confidence: 99%

Section: Epidural Analgesicsmentioning

confidence: 99%

Section: Epidural Analgesicsmentioning

confidence: 99%

Section: Techniques Evidence Adult Evidence Pediatricmentioning

confidence: 99%

See 3 more Smart Citations

Perioperative pain management for spine surgeries

Sikachi,

Oliver,

Oliver

et al. 2023

International Anesthesiology Clinics

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A Randomized Controlled Trial Using Epidural Analgesia for Pain Relief After Lumbar Interlaminar Decompressive Spine Surgery

Hermans,

Lantinga-Zee,

Droeghaag

et al. 2024

Spine

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Study Design: Prospective, double blind randomized controlled trial. Objective: If an intraoperative single bolus of epidural bupivacaine can result in less postoperative pain following lumbar spinal decompression surgery. Summary of Background Data: Adequate postoperative pain management following lumbar spinal decompression surgery is important as it will lead to early mobilization, less complications and shorter hospital stay. Opioid consumption should be limited due to their frequently accompanied side effects and their addictive nature. During the final phase of lumbar decompression surgery, the epidural space becomes easily accessible. This might be an ideal moment for surgeons to administer an epidural bolus of analgesia, as a safe and effective method for post-operative pain relief. Methods: In this trial we compared a single intraoperative bolus of epidural analgesia using bupivacaine 0.25% to placebo (NaCl 0,9%) and its effect on postoperative pain following lumbar spinal decompression surgery. The primary outcome was the difference in NRS between the intervention and placebo groups during the first 48h after surgery. Results: Both the intervention group and the placebo group consisted of 20 randomized patients (N=40). Statistically significant lower mean NRS pain scores were observed in the intervention group in comparison with the control group (main effect group: -2.35 (±0.77), P=0.004). The average pain score was lower in the intervention group at all postoperative time-points. No study related complications occurred. Conclusion: This randomized controlled trial shows that administrating a bolus of intraoperative epidural bupivacaine is a safe and effective method in reducing early postoperative pain following lumbar decompression surgery.

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Single-dose epidural bupivacaine vs placebo after lumbar decompression surgery: A Randomized controlled trial

Hermans,

Lantinga-Zee,

Droeghaag

et al. 2023

Preprint

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IntroductionAdequate postoperative pain management following lumbar spinal decompression surgery is important as it will lead to early mobilization, less complications and shorter hospital stay. Opioid consumption should be limited due to their frequently accompanied side effects and their addictive nature. During the final phase of lumbar decompression surgery, the epidural space becomes easily accessible. This might be an ideal moment for surgeons to administer an epidural bolus of analgesia, as a safe and effective method for post-operative pain relief.MethodsThis is a double blind randomized controlled trial comparing a single intraoperative bolus of epidural analgesia using bupivacaine 0.25% to placebo (NaCl 0,9%) and its effect on postoperative pain following lumbar spinal decompression surgery. The primary outcome was the difference in NRS pain between the intervention and placebo groups during the first 48h after surgery. It was hypothesized that the intervention group will have lower postoperative NRS pain scores.ResultsBoth the intervention group and the placebo group consisted of 20 randomized patients (N=40). We observed statistically significant lower NRS pain scores in the intervention group in comparison with the control group, with a difference of −1.9 (±1.1). The average pain score was lower in the intervention group at all postoperative time-points. Opioid consumption, quality of life and satisfaction were similar between study groups. No study related complications occurred, and complications rate did not differ between study groups.ConclusionThis randomized controlled trial shows that administrating a bolus of intraoperative epidural bupivacaine is a safe and effective method in reducing early postoperative pain following lumbar decompression surgery.

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Intraoperative epidural analgesia for pain relief after lumbar decompressive spine surgery: A systematic review and meta-analysis

Cited by 3 publications

References 51 publications

Perioperative pain management for spine surgeries

Perioperative pain management for spine surgeries

A Randomized Controlled Trial Using Epidural Analgesia for Pain Relief After Lumbar Interlaminar Decompressive Spine Surgery

Single-dose epidural bupivacaine vs placebo after lumbar decompression surgery: A Randomized controlled trial

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