POSTOPERATIVE PAIN CONTROL AFTER LUMBAR SPINE FUSION - PATIENT-CONTROLLED ANALGESIA VERSUS CONTINUOUS EPIDURAL ANALGESIA

Study Design. A prospective, randomized, double-blind clinical trial. Objective. To compare the efficacy of postoperative continuous epidura l analgesia versus patient-controlled analgesia in patients undergoing lumbar fusion. Summary of Background Data. Controversy remains regard ing the optimal strategy for postoperative pain control. Methods. Fift y-four patients were divided into two treatment groups. There was no d ifference between the groups with respect to age, levels fused, estima ted blood loss, and use of spinal instrumentation. Patient-controlled analgesia or epidural analgesia was administered in a double-blind man ner for a 3-day postoperative course. Each patient received both an ep idural and a patient-controlled analgesia delivery system; 26 received the epidural active agent and 28 received patient-controlled analgesi a. Postoperative time to liquids and solid food, ambulation, length of stay, and side effects was recorded. Pain was evaluated by a visual a nalog scale on postoperative days 1, 2, and 3. Results. Results showed no difference between the groups with reference to diet, ambulation, length of stay, and visual analog scale scores. Minor side effects occ urred in 71% of patients in both groups. No major complications occurr ed. Epidural catheter dislodgment occurred in 11% of patients. The tot al cost for epidural analgesia was approximately $550 more than that f or patient-controlled analgesia for a 3-day postoperative course. Conc lusions. These data suggest that there is no clinical advantage of epi dural opiate/local anesthetic analgesia over systemic opiate by patien t-controlled analgesia for spinal fusion patients. However, possible t echnical limitations (namely, the low dosage of bupivacaine and placem ent of the catheter tip) may have prevented adequate delivery of anest hetic to the involved segments. Although the incidence of side effects is similar, cost factors and a high incidence of epidural catheter di slodgment favor use of patient-controlled analgesia.