The addition of epidural local anesthetic to systemic multimodal analgesia following lumbar spinal fusion: a randomized controlled trial

Abstract

This randomized trial aimed to evaluate the effects of adding continuous epidural analgesia with a bupivacaine and hydromorphone solution to systemic multimodal analgesia following one- or two-level lumbar spinal fusion. Thirty-nine patients undergoing lumbar spinal fusion, stratified for sex and one- or two-level fusion, were randomized to receive a continuous postoperative epidural infusion of either 0.1% bupivacaine with 15μg·mL(-1) hydromorphone (LA group) or 0.9% saline (NS group) at 6mL·hr(-1) for 48hr through an epidural catheter placed intraoperatively. All patients received a standardized postoperative multimodal analgesia regimen. Patients, healthcare providers, and research staff were blinded. The primary outcome measure was cumulative opioid consumption (oral morphine equivalent) during the first 48hr postoperatively. The mean (SD) cumulative opioid consumption 48hours postoperatively was 249.3 (143.3) mg in the NS group and 184.7 (208.1)mg in the LA group (mean difference 64.6mg; 95% confidence interval -54.3 to 183.5; P=0.27). There were no adverse events in either group. Continuous epidural infusion combined with systemic multimodal analgesia resulted in a mean reduction in 48-hr cumulative opioid consumption of 64.6mg (95% confidence interval -54.3 to 183.5) following one- or two-level lumbar spinal fusion. This estimate of effect is imprecise, and the routine use of continuous epidural analgesia in this surgical population is not yet warranted. This trial was registered at www.clinicaltrials.gov : NCT00644111.