TY - JOUR
T1 - Intraoperative epidural analgesia for pain relief after lumbar decompressive spine surgery
T2 - A systematic review and meta-analysis
AU - Hermans, Sem M.M.
AU - Lantinga-Zee, Aniek A.G.
AU - Rijkers, Kim
AU - van Santbrink, Henk
AU - van Hemert, Wouter L.W.
AU - Reinders, Mattheus K.
AU - Hoofwijk, Daisy M.N.
AU - van Kuijk, Sander M.J.
AU - Curfs, Inez
N1 - Publisher Copyright:
© 2021 The Authors
PY - 2021/1/1
Y1 - 2021/1/1
N2 - Introduction: During lumbar decompressive spine surgery, the epidural space is easily accessible. This intraoperative situation allows surgeons to apply an epidural bolus of analgesia at the end of the surgical procedure. In literature, several papers about the methods and effectiveness of delivering local analgesia during lumbar decompressive spine surgery have been published. Research question: This systematic review and meta-analysis aims to summaries the current literature on the effectiveness and safety of intraoperative epidural analgesia in lumbar decompressive surgery, delivered as a bolus. Material and method: A systematic search was conducted according to the PRISMA guidelines. Inclusion criteria were randomized controlled trials or comparative cohort studies of patients aged 18 years or older who underwent decompressive lumbar spine surgery. Nonsteroidal epidural analgesia had to be administered as a bolus, intraoperatively, as an adjunct to standard analgesia therapy. Primary outcome measures were reduction in postoperative pain scores, analgesics consumption and length of hospital stay. Secondary outcomes were adverse events. Results: Eight studies evaluating the effectiveness of intraoperative epidural analgesia were included. Seven studies reported statistically significant reductions in postoperative VAS-pain scores. Six studies reported a statistically significant decrease in postoperative analgesics consumption. Four studies reported on the length of hospital stay, with no statistically significant difference between study groups. Discussion and conclusion: This systematic review and meta-analysis suggests that additional intraoperative epidural nonsteroidal analgesia, delivered as a bolus, can reduce postoperative pain and postoperative analgesics consumption in patients undergoing decompressive spinal surgery. Further well-powered research is needed to bolster the evidence.
AB - Introduction: During lumbar decompressive spine surgery, the epidural space is easily accessible. This intraoperative situation allows surgeons to apply an epidural bolus of analgesia at the end of the surgical procedure. In literature, several papers about the methods and effectiveness of delivering local analgesia during lumbar decompressive spine surgery have been published. Research question: This systematic review and meta-analysis aims to summaries the current literature on the effectiveness and safety of intraoperative epidural analgesia in lumbar decompressive surgery, delivered as a bolus. Material and method: A systematic search was conducted according to the PRISMA guidelines. Inclusion criteria were randomized controlled trials or comparative cohort studies of patients aged 18 years or older who underwent decompressive lumbar spine surgery. Nonsteroidal epidural analgesia had to be administered as a bolus, intraoperatively, as an adjunct to standard analgesia therapy. Primary outcome measures were reduction in postoperative pain scores, analgesics consumption and length of hospital stay. Secondary outcomes were adverse events. Results: Eight studies evaluating the effectiveness of intraoperative epidural analgesia were included. Seven studies reported statistically significant reductions in postoperative VAS-pain scores. Six studies reported a statistically significant decrease in postoperative analgesics consumption. Four studies reported on the length of hospital stay, with no statistically significant difference between study groups. Discussion and conclusion: This systematic review and meta-analysis suggests that additional intraoperative epidural nonsteroidal analgesia, delivered as a bolus, can reduce postoperative pain and postoperative analgesics consumption in patients undergoing decompressive spinal surgery. Further well-powered research is needed to bolster the evidence.
KW - Additional analgesics
KW - Analgesic paste
KW - Analgesic sponge
KW - Decompressive lumbar surgery
KW - Hospital stay
KW - Interlaminar decompression
KW - Intraoperative epidural analgesia
KW - Laminectomy
KW - Nonsteroidal analgesia
KW - Pain control
UR - http://www.scopus.com/inward/record.url?scp=85151933060&partnerID=8YFLogxK
U2 - 10.1016/j.bas.2021.100306
DO - 10.1016/j.bas.2021.100306
M3 - (Systematic) Review article
SN - 2772-5294
VL - 1
JO - Brain and Spine
JF - Brain and Spine
M1 - 100306
ER -