Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Woo-Suk Song; Young-Sang Lee; Byoung-Hark Park; Jeong-Muk Kim; Chan-Woong Byun

doi:10.4184/jkss.2018.25.3.122

Journal List > J Korean Soc Spine Surg > v.25(Suppl 1) > 1125264

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Song, Lee, Park, Kim, and Byun: Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Original Article

Journal of Korean Spine Surg 2018;25(3):122-127.

Published online: 30 September 2018

DOI: https://doi.org/10.4184/jkss.2018.25.3.122

Comparison of Postoperative Pain Control Methods in Patients with Spinal Stenosis after Posterior Spinal Decompression

Woo-Suk Song, M.D., Young-Sang Lee, M.D.^∗,, Byoung-Hark Park, M.D., Jeong-Muk Kim, M.D., Chan-Woong Byun, M.D.

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Seongnam, Korea

^∗Department of Anesthesia and Pain Medicine, Bundang Jesaeng General Hospital, Seongnam, Korea

Corresponding author: Young-Sang Lee, M.D. Department of Orthopaedic Surgery, Bundang Jesaeng General Hospital, 180 gil 20 Seohyun-ro, Bundang-gu, Seongnam 13590, Korea ORCID ID: Woo-Suk Song: https://orcid.org/0000-0001-7556-6293 Young-Sang Lee: https://orcid.org/0000-0002-2206-3593 Byoung-Hark Park: https://orcid.org/0000-0002-3785-0071 Jeong-Muk Kim: https://orcid.org/0000-0003-0609-3626 Chan-Woong Byun: https://orcid.org/0000-0002-0852-0217 TEL: +82-31-779-0175, FAX: +82-31-779-0179 E-mail: yslee2808@gmail.com

Received 3 May 201811 July 2018 Accepted 4 September 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Prospective study.

Objectives

This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with 3 methods of pain control after posterior spinal decompression.

Summary of Literature Review

Spinal surgery causes severe postoperative pain. Efficient and safe methods for postoperative analgesia after spinal surgery are necessary.

Materials and Methods

To determine the clinical symptoms and to assess improvements in postoperative pain, 52 patients in whom single-level posterior lumbar decompression was planned were randomly assigned to 3 groups. For postoperative pain control, 18 patients received a preoperative single-shot epidural injection (SEI), 16 patients received a postoperative continuous epidural injection (CEI), and 18 patients received only postoperative intravenous patient-controlled analgesia (IV-PCA). Patient ratings of pain intensity (visual analog scale score from 0 [no pain] to 10 [most severe pain]), nausea (from 0 [no nausea] to 5 [severe nausea]), and vomiting (from 0 [no vomiting] to 5 [severe vomiting]) were recorded immediately after the operation and at 4 hours, 12 hours, 1 day, and 2 days postoperatively.

Results

The CEI group showed significantly enhanced analgesic effects, followed by the SEI group and the IV PCA group (p<0.05). PONV due to postoperative pain control was more severe in the IV PCA group than in the other 2 groups (p<0.05).

Conclusions

Continuous epidural injection (CEI) is effective for postoperative pain control and minimizes the occurrence of PONV after posterior spinal decompression.

Keywords: Postoperative pain control, IV-PCA, SEI, CEI

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Fig. 1.

Time course of postoperative in the SEI, CEI and IV-PCA groups assessed by VAS. Values are mean.

Table 1.

patient characterics

	SEI	CEI	IV-PCA	p-value
Age (years)	63.3±9.6	67.0±11.4	72.1±9.8	0.055
Gender
Male	7 (38.9%)	6 (37.5%)	8 (44.4%)	0.907
Female	11 (61.1%)	10 (62.5%)	10 (55.6%)
Operation
Post. decomp. only	16 (94.4%)	16 (100.0%)	18 (100.0%)	0.382
+Discectomy	1 (5.6%)	0 (0.0%)	0 (0.0%)

SEI: single-shot epidural injection, CEI: continuous epidural injection.

Table 2.

Side-effects of each pain control methods

	SEI	CEI	IV-PCA	p-value
Nausea	2(11%) (POD #1)	0	2(11%) (post 12hrs)	<0.001
			3(17%) (POD #1)
			3(17%) (POD #2)
Vomiting	2(11%) (POD #1)	0	1(6%) (post 12hrs)	<0.001
			2(11%) (POD #1)
			2(11%) (POD #2)

Table 3.

Visual analogue scales among three groups in consecutive time points after surgery

	SEI	CEI	IV-PCA	p-value
immediate post	5.78±0.732	5.94±1.181	6.44±1.097	0.133
post 4hr	5.06±0.725	4.44±0.629	5.50±1.200	0.005
post 12hr	4.28±1.074	4.06±0.772	5.33±1.188	0.001
POD #1	2.78±0.647	3.00±0.816	3.89±0.963	<0.001
POD #2	2.33±0.767	2.44±0.727	2.67±0.594	0.352

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