ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2025
"Beyond the incision": A case-control study on IV and epidural pre-emptive analgesia in lumbar spine surgery.
Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionEffective pain management in lumbar spine surgery is critical to enhancing postoperative recovery and minimizing complications. Preemptive analgesia, administered either intravenously or epidurally, has shown promise in controlling pain; however, limited data exist comparing the two routes directly to determine the optimal approach for lumbar procedures. PURPOSE: To evaluate and compare pain control efficacy, recovery outcomes, and postoperative complications between IV and epidural preemptive analgesia routes in lumbar spine surgeries.
methodsA prospective, double blinded study comparing the efficacy of intravenous (IV) and epidural preemptive analgesia in patients undergoing lumbar spine surgery. Patients undergoing lumbar spine surgery were divided into three groups based on the analgesia route: Epidural, IV and Control respectively. Pain scores, analgesic consumption, and recovery profiles were assessed postoperatively. Statistical analyses, including ANOVA and Chi-square tests, were used to evaluate differences in pain control and recovery outcomes between groups.
resultsVAS scores at 4, 8, 12, and 24 h postoperatively were significantly different among groups (p < 0.0001). Group 1 (epidural) reported scores of 5.13 ± 0.86, 4.97 ± 0.93, 3.23 ± 0.94, and 3.17 ± 0.91; Group 2 (IV): 6.79 ± 1.29, 5.07 ± 0.92, 3.79 ± 1.18, and 3.21 ± 0.94; Group 3 (control): 8.92 ± 0.84, 6.96 ± 0.84, 5.82 ± 0.81, and 5.55 ± 0.50. Time to first analgesic was 26.00 ± 9.77 min (G1), 25.00 ± 9.82 min (G2), and 10.41 ± 3.51 min (G3) (p < 0.0001). Total 24-hour consumption: fentanyl- G1: 32.20 ± 4.99 mcg, G2: 30.90 ± 8.78, G3: 62.55 ± 12.34; paracetamol- 1.00 ± 0.00, 1.03 ± 0.19, 2.00 ± 0.00 g; ketorolac- 50.00 ± 0.00, 51.72 ± 9.28, 100.00 ± 0.00 mg; tramadol- 45.00 ± 15.26, 49.66 ± 16.58, 73.47 ± 15.08 mg (all p < 0.0001).
conclusionThis study fills a critical gap by directly comparing IV and epidural pre-emptive analgesia in lumbar spine surgery, providing insights for clinical decision-making. Findings suggest IV analgesia offers comparable pain control to epidural, presenting a safer alternative with fewer procedural risks. Results hold valuable implications for optimizing perioperative care. LEVEL OF EVIDENCE: Level IV.
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