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MINERVA ANESTESIOLOGICA

Rivista di Anestesia, Rianimazione, Terapia Antalgica e Terapia Intensiva


Official Journal of the Italian Society of Anesthesiology, Analgesia, Resuscitation and Intensive Care
Indexed/Abstracted in: Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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Minerva Anestesiologica 2017 Oct 04

DOI: 10.23736/S0375-9393.17.12136-X

Copyright © 2017 EDIZIONI MINERVA MEDICA

lingua: Inglese

Intra- versus postoperative initiation of pain control via a thoracic epidural catheter for lumbar spinal fusion surgery: a randomised trial

Manuel WENK 1 , Ulf LILJENQVIST 3, Thomas KAULINGFRECKS 2, Simone GURLIT 2, Thomas ERMERT 1, Daniel M. PÖPPING 1, Michael MÖLLMANN 2

1 Department of Anesthesiology and Intensive Care, University Hospital Muenster, Muenster, Germany; 2 Department of Anesthesiology and Intensive Care, St. Franziskus Hospital Muenster, Muenster, Germany; 3 Department of Spine Surgery, St. Franziskus Hospital Muenster, Muenster, Germany


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BACKGROUND: Thoracic epidural anesthesia (TEC) is one of the pillars of preoperative pain care. Particularly for spine surgery which causes significant postoperative pain TEC seems like an appealing option. However, beneficial effects of a TEC are questionable when the catheter is not used intraoperatively, a decision that is usually based on the surgeon’s wish to perform immediate neurological examination postoperatively.
METHODS: 40 patients undergoing transforaminal lumbar interbody fusion surgery (TLIF) were randomized in two groups. Patients received pre-operative insertion of a TEC. For patients in the intraop group an epidural infusion was started preoperatively and maintained throughout. For patients in the postop group the epidural infusion was started once neurological examination had been performed. The primary outcome measure in this study was postoperative requirements of piritramide during the first two postoperative hours. Secondary outcomes involved postoperative pain numeric rating scale (NRS) scores, intraoperative opioid requirements, side effects and ability to perform direct postoperative neurological examination.
RESULTS: Postop group patients required significantly more opioids both intra- and postoperatively (p=0.036 and p=0.039) and NRS scores were significantly higher on admission to recovery, at 30 and 60 min as compared to patients in the intraop group (p=0,013; p=0.004 and p=0.012). Early postoperative neurological examination was feasible in all patients in both groups.
CONCLUSIONS: Epidural catheters used intraoperatively during TLIF are feasible, significantly reduce pain, intra- and postoperative use of opioids and do not influence the quality of neurological tests directly after the surgical procedure.


KEY WORDS: Lumbar spinal fusion - Epidural catheter - Analgesic techniques - Anaesthetics local

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Publication History

Article first published online: October 04, 2017
Manuscript accepted: September 26, 2017
Manuscript revised: September 20, 2017
Manuscript received: April 15, 2017

Per citare questo articolo

Wenk M, Liljenqvist U, Kaulingfrecks T, Gurlit S, Ermert T, Pöpping DM, et al. Intra-versus postoperative initiation of pain control via a thoracic epidural catheter for lumbar spinal fusion surgery: a randomised trial. Minerva Anestesiol 2017 Oct 04. DOI: 10.23736/S0375-9393.17.12136-X

Corresponding author e-mail

manuelwenk@uni-muenster.de