Résumé
Background: Pain management after posterior thoracolumbar interbody fusion surgery remains a challenging problem. Epidural analgesia with local anesthetics as an adjuvant treatment might prove beneficial.
Objective: To evaluate the effects of continuous epidural analgesia with a ropivacaine solution as an adjuvant treatment after posterior thoracolumbar interbody fusion.
Study design: A prospective double-blind, randomized, placebo-controlled clinical trial.
Setting: University Hospital Brussels, a tertiary academic health science centre.
Methods: Thirty-three patients undergoing spinal fusion surgery were randomized into two groups. One group was administered a continuous epidural infusion of a 0.9% saline solution. The oilier group was administered a continuous epidural infusion of a 0.2% ropivacaine solution. The primary outcome measure was the level of pain experienced by the patients, which was assessed using the visual analogue scale (VAS). Secondary outcomes were time to mobilisation, total length of stay and opioid consumption on patient demand.
Results: The mean VAS score postoperatively the day of surgery was scored as 3,5 for the patients receiving the ropivacaine infusion. The placebo group scored 5 on the VAS scale, thus suggesting a beneficial effect of ropivacaine infusion (p-value 0.02). The mean VAS score at post-op day 1 of surgety differed between 2 for the ropivacaine group and 2,8 for the placebo group (p-value 0.05). Length of stay was shorter for patients who had received ropivacaine infusion (mean difference 1,8 days ; p-value 0,02). No other significant differences were withheld.
Conclusion: The use of a continuous epidural ropivacaine infusion after posterior thoracolumbar spinal fusion surgery could improve postoperative VAS scores and may also result in faster hospital discharge rate. Trial registration : registered and approved in the EudraCT registry (2014-004713-91).