A comparison of three types of postoperative pain control after posterior lumbar spinal surgery.

摘要

STUDY DESIGN: Retrospective, nonrandomized, comparative study. OBJECTIVE: This study compared the early postoperative analgesic effects and the postoperative nausea and vomiting (PONV) associated with three methods of pain control after posterior lumbar spinal surgery. SUMMARY OF BACKGROUND DATA: The use of opioids for postoperative pain control is common after spinal surgery; however, PONV is the most frequently encountered side effect, and it is yet to be overcome. The effectiveness of the use of an absorbable low-dose morphine-soaked microfibrillar collagen hemostatic sponge placed on the surface of the dural sac (epidural MMCHS) was compared to patient-controlled analgesia (PCA) and intermittent intramuscular bolus injection of meperidine for postoperative pain control after spine surgery. METHODS: One hundred sixty-five patients who underwent short-segment posterior lumbar spinal decompression and fusion surgery between January 2007 and July 2007 in the orthopedic department of a medical center were enrolled. For postoperative pain control, 40 patients received epidural MMCHS, 48 patients received PCA, and 77 patients received meperidine injection. 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 at 4 hours postoperation and on postoperative days 1, 2, and 3. RESULTS: The analgesic effect was enhanced significantly in both epidural MMCHS group and the PCA group as compared with the meperidine group on postoperative days 1 and 2 (P < 0.05). On postoperative days 1, 2, and 3, PONV was more severe in the PCA group than in the other two groups (P < 0.05). The side effects of epidural MMCHS were nausea (25%), pruritus (12.5%), vomiting (5%), and hypotension (2.5%). CONCLUSION: A single low-dose epidural MMCHS is effective for postoperative pain control and minimizes the occurrence of PONV after posterior lumbar spinal surgery.