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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Comparison of patient-controlled epidural analgesia and patient-controlled intravenous analgesia after spinal fusion surgery: a meta-analysis of randomized controlled trials

Authors: Peng Tian, Xin Fu, Zhi-jun Li, Xin-long Ma

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

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Abstract

Background

The objective of this meta-analysis was to compare the efficacy and safety of patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) in postoperative analgesia of spinal fusion surgery.

Methods

Potential academic articles were identified from the Cochrane Library, Medline (1966–2015.5), PubMed (1966–2015.5), Embase (1980–2015.5) and ScienceDirect (1966–2015.5). Gray studies were identified from the references of the included literature. Randomized controlled trials (RCTs) involving PCEA and PCIA after spinal fusion were included. Two independent reviewers performed independent data abstraction. I2 statistic was used to assess heterogeneity. Fixed or random effects model was used for meta-analysis.

Results

Eight RCTs met the inclusion criteria. There was a better analgesic effect in patients with PCEA for postoperative VAS on the first day (P = 0.0005) and second day (P = 0.006). The patients with PCEA had a higher incidence of pruritus (P = 0.02) and paresthesia (P = 0.03) after surgery than those with PCIA. There was no statistically significant difference in postoperative VAS on the third day (P = 0.15), nausea (P = 0.74) or emesis (P = 0.37) between the two groups.

Conclusions

After spinal fusion, the patients with PCEA have similar analgesic efficacy during the three postoperative days and a higher incidence of pruritus and paresthesia than those with PCIA. Due to the limited quality and data of the evidence currently available, more high-quality randomized controlled trials are required.
Literature
1.
2.
3.
Gu G, Zhang H, Fan G, He S, Cai X, Shen X, et al. Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. Int Orthop. 2014;38(4):817–24.PubMedCentralCrossRefPubMed
4.
Kotani Y, Abumi K, Ito M, Sudo H, Abe Y, Minami A. Mid-term clinical results of minimally invasive decompression and posterolateral fusion with percutaneous pedicle screws versus conventional approach for degenerative spondylolisthesis with spinal stenosis. European spine journal. 2012;21(6):1171–7.PubMedCentralCrossRefPubMed
5.
Xu L, Zhu F, Zhu Z, Liu Z, Sun X, Qiao J, et al. Comparison of 2 methods of incision closure in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery. Spine. 2014;39(8):E481–485.CrossRefPubMed
6.
Barrey C, Darnis A. Current strategies for the restoration of adequate lordosis during lumbar fusion. World J Orthod. 2015;6(1):117–26.CrossRef
7.
Djurasovic M, Glassman SD, Dimar 2nd JR, Howard JM, Bratcher KR, Carreon LY. Does fusion status correlate with patient outcomes in lumbar spinal fusion? Spine. 2011;36(5):404–9.PubMed
8.
Pearson AM, Lurie JD, Tosteson TD, Zhao W, Abdu WA, Weinstein JN. Who should undergo surgery for degenerative spondylolisthesis? Treatment effect predictors in SPORT. Spine. 2013;38(21):1799–811.CrossRefPubMed
9.
Tsutsumimoto T, Shimogata M, Yoshimura Y, Misawa H. Union versus nonunion after posterolateral lumbar fusion: a comparison of long-term surgical outcomes in patients with degenerative lumbar spondylolisthesis. European spine journal. 2008;17(8):1107–12.PubMedCentralCrossRefPubMed
10.
Bianconi M, Ferraro L, Ricci R, Zanoli G, Antonelli T, Giulia B, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound instillation after spine fusion surgery. Anesth Analg. 2004;98(1):166–72. table of contents.CrossRefPubMed
11.
Ziegeler S, Fritsch E, Bauer C, Mencke T, Muller BI, Soltesz S, et al. Therapeutic effect of intrathecal morphine after posterior lumbar interbody fusion surgery: a prospective, double-blind, randomized study. Spine. 2008;33(22):2379–86.CrossRefPubMed
12.
Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol. 2008;21(3):313–6.CrossRefPubMed
13.
Wu MH, Wong CH, Niu CC, Tsai TT, Chen LH, Chen WJ. A comparison of three types of postoperative pain control after posterior lumbar spinal surgery. Spine. 2011;36(25):2224–31.CrossRefPubMed
14.
Apfelbaum JL, Chen C, Mehta SS, Gan TJ. Postoperative pain experience: results from a national survey suggest postoperative pain continues to be undermanaged. Anesth Analg. 2003;97(2):534–40. table of contents.CrossRefPubMed
15.
Blumenthal S, Borgeat A, Nadig M, Min K. Postoperative analgesia after anterior correction of thoracic scoliosis: a prospective randomized study comparing continuous double epidural catheter technique with intravenous morphine. Spine. 2006;31(15):1646–51.CrossRefPubMed
16.
Yukawa Y, Kato F, Ito K, Terashima T, Horie Y. A prospective randomized study of preemptive analgesia for postoperative pain in the patients undergoing posterior lumbar interbody fusion: continuous subcutaneous morphine, continuous epidural morphine, and diclofenac sodium. Spine. 2005;30(21):2357–61.CrossRefPubMed
17.
Gauger VT, Voepel-Lewis TD, Burke CN, Kostrzewa AJ, Caird MS, Wagner DS, et al. Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. J Pediatr Orthop. 2009;29(6):588–93.CrossRefPubMed
18.
Klatt JW, Mickelson J, Hung M, Durcan S, Miller C, Smith JT. A randomized prospective evaluation of 3 techniques of postoperative pain management after posterior spinal instrumentation and fusion. Spine. 2013;38(19):1626–31.CrossRefPubMed
19.
Kluba T, Hofmann F, Bredanger S, Blumenstock G, Niemeyer T. Efficacy of post-operative analgesia after posterior lumbar instrumented fusion for degenerative disc disease: a prospective randomized comparison of epidural catheter and intravenous administration of analgesics. Orthop Rev. 2010;2(1):e9.CrossRef
20.
Cassady Jr JF, Lederhaas G, Cancel DD, Cummings RJ, Loveless EA. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med. 2000;25(3):246–53.PubMed
21.
Cohen BE, Hartman MB, Wade JT, Miller JS, Gilbert R, Chapman TM. Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia. Spine. 1997;22(16):1892–6. discussion 1896–1897.CrossRefPubMed
22.
Fisher CG, Belanger L, Gofton EG, Umedaly HS, Noonan VK, Abramson C, et al. Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine. 2003;28(8):739–43.PubMed
23.
Schenk MR, Putzier M, Kugler B, Tohtz S, Voigt K, Schink T, et al. Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia. Anesth Analg. 2006;103(5):1311–7.CrossRefPubMed
24.
Johnson RG, Miller M, Murphy M. Intraspinal narcotic analgesia. A comparison of two methods of postoperative pain relief. Spine. 1989;14(4):363–6.CrossRefPubMed
25.
Block BM, Liu SS, Rowlingson AJ, Cowan AR, Cowan Jr JA, Wu CL. Efficacy of postoperative epidural analgesia: a meta-analysis. Jama. 2003;290(18):2455–63.CrossRefPubMed
26.
Dolin SJ, Cashman JN, Bland JM. Effectiveness of acute postoperative pain management: I. Evidence from published data. Br J Anaesth. 2002;89(3):409–23.CrossRefPubMed
27.
Joshi GP, McCarroll SM, O’Rourke K. Postoperative analgesia after lumbar laminectomy: epidural fentanyl infusion versus patient-controlled intravenous morphine. Anesth Analg. 1995;80(3):511–4.PubMed
28.
Ngan Kee WD, Lam KK, Chen PP, Gin T. Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia using pethidine or fentanyl. Anaesth Intensive Care. 1997;25(2):126–32.PubMed
29.
Cooper DW, Ryall DM, Desira WR. Extradural fentanyl for postoperative analgesia: predominant spinal or systemic action? Br J Anaesth. 1995;74(2):184–7.CrossRefPubMed
30.
Correll DJ, Viscusi ER, Grunwald Z, Moore Jr JH. Epidural analgesia compared with intravenous morphine patient-controlled analgesia: postoperative outcome measures after mastectomy with immediate TRAM flap breast reconstruction. Reg Anesth Pain Med. 2001;26(5):444–9.PubMed
31.
Kim EJ, Shim JK, Soh S, Song JW, Lee SR, Kwak YL: Patient-controlled Analgesia With Propacetamol-Fentanyl Mixture for Prevention of Postoperative Nausea and Vomiting in High-risk Patients Undergoing Spine Surgery: A Randomized Controlled Trial. Journal of neurosurgical anesthesiology 2015. Epub ahead of print]
32.
Cepeda MS, Farrar JT, Roa JH, Boston R, Meng QC, Ruiz F, et al. Ethnicity influences morphine pharmacokinetics and pharmacodynamics. Clin Pharmacol Ther. 2001;70(4):351–61.CrossRefPubMed
33.
Lachiewicz PF. The role of intravenous acetaminophen in multimodal pain protocols for perioperative orthopedic patients. Orthopedics. 2013;36(2 Suppl):15–9.CrossRefPubMed
Metadata
Title
Comparison of patient-controlled epidural analgesia and patient-controlled intravenous analgesia after spinal fusion surgery: a meta-analysis of randomized controlled trials
Authors
Peng Tian
Xin Fu
Zhi-jun Li
Xin-long Ma
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0849-y

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