Effect of epidural patient-controlled analgesia on pain relief after lumbar spinal surgeries-a case-control study.

Abstract

PurposePatients withspinal degenerative diseases are often older and have multiple comorbidities. This study aims to evaluate the impact of epidural patient-controlled analgesia (PCA) on postoperative pain relief in patients undergoing lumbar spine surgeries for spinal degenerative diseases.MethodsThis retrospective case-control study included patients who underwent lumbar spine surgeries for degenerative spinal stenosis, spondylolisthesis, herniated intervertebral discs, or osteoporotic spinal fractures with spinal stenosis. The PCA group consisted of patients who received 72-h epidural PCA for postoperative pain control, while the control group received standard postoperative pain management. All patients were allowed to request intramuscular rescue analgesics for additional pain control. The primary endpoint was defined as the mean visual analogue scale (VAS) score during the effective PCA period (postoperative day [POD] 1-3). Secondary endpoints included individual daily VAS scores, rebound pain, rescue analgesic injections, morphine consumption, drainage duration, drainage volume, length of hospital stay, and complications.ResultsA total of 209 patients (mean age 73.8 years) were included, with 88 patients in the PCA group and 121 in the control group. Mean VAS score across POD 1-3 was significantly lower in the PCA group (Cohen's <i>d</i> = -1.89, 95% CI = -2.22 to -1.56, <i>p</i> < 0.001). During hospitalization, the PCA group required significantly fewer rescue analgesic injections (Cohen's d = -2.47, 95% CI = -2.84 to -2.11) and less total morphine consumption (Cohen's <i>d</i> = -0.39, 95% CI = -0.67 to -0.11) compared to the control group. Although the PCA group experienced greater drainage volume and longer duration of drainage placement, the incidence of infection and the length of hospital stay were comparable between the two groups.ConclusionIn this real-world cohort of elderly patients with multiple comorbidities undergoing lumbar spinal surgery, epidural PCA provided effective pain relief without an observed increase in infection rates in this study population.