Postoperative Pain Control with Epidural Catheter after Posterior Lumbar Spine Fusion

Abstract

Introduction Pain management after posterior spinal fusion surgeries is a challenging topic. Epidural analgesia (CEA) technique has been developed to resolve some deleterious effects related with conventional intravenous patient-controlled analgesia (IV-PCA) method. However, studies are scanty in adult lumbar deformity patients. We hypothesized that CEA would be beneficial in adult lumbar deformity patients and conducted a study to observe effectiveness and safety of the procedure with a special consideration of the catheter level. Patients and Methods Forty-six patients scheduled for elective posterior lumbar spine fusion, in one spine-center clinic, were enrolled into the study. Three patients' dataset about pain control and/or sedation status were inconclusive and they were excluded from the final analysis. Pain and sedation status were evaluated with VAS and Ramsay sedation scales, respectively. Epidural catheter was inserted under direct visualization intraoperatively. Results There were 43 patients in the final analysis. Twenty-one patients had epidural catheters at or below the L2 level, 22 patients had their catheters above the predefined level. There was significant difference between the groups only in the 24th hour VAS scores. Patients with catheters of higher level location in the spinal canal, had higher VAS scores at the immediate postoperative period, however VAS scores in this group lessened more than the lower level catheter group at the 24th hour. Ramsay sedation scale score was significantly slightly higher in the patients with lower level catheters than the other group at 0 and the 2nd hour. Conclusion Continuous epidural analgesia is an effective and safe method in controlling postoperative pain in adult lumbar deformity patients treated with PSF method. Higher placement of epidural catheter in the spinal canal causes more pain at the beginning; however, drug release at this level has more effect over pain than lower levels.