Evaluation of a Single-Dose, Extended-Release Epidural Morphine Formulation for Pain Control After Lumbar Spine Surgery

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA).OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.

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Patient-controlled Epidural Analgesia (PCEA) for Postoperative Pain Control After Lumbar Spine Surgery

Journal of Neurosurgical Anesthesiology ◽

10.1097/ana.0b013e31817ffe90 ◽

2008 ◽

Vol 20 (4) ◽

pp. 256-260 ◽

Cited By ~ 17

Author(s):

Juan P. Cata ◽

Edward M. Noguera ◽

Emily Parke ◽

Zeyd Ebrahim ◽

Andrea Kurz ◽

...

Keyword(s):

Lumbar Spine ◽

Postoperative Pain ◽

Epidural Analgesia ◽

Spine Surgery ◽

Pain Control ◽

Lumbar Spine Surgery ◽

Postoperative Pain Control

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Effective prevention of surgical site infection using a Centers for Disease Control and Prevention guideline–based antimicrobial prophylaxis in lumbar spine surgery

Journal of Neurosurgery Spine ◽

10.3171/spi.2007.6.4.7 ◽

2007 ◽

Vol 6 (4) ◽

pp. 327-329 ◽

Cited By ~ 51

Author(s):

Masahiro Kanayama ◽

Tomoyuki Hashimoto ◽

Keiichi Shigenobu ◽

Fumihiro Oha ◽

Daisuke Togawa

Keyword(s):

Single Dose ◽

Lumbar Spine ◽

Surgical Site Infection ◽

Spine Surgery ◽

Multiple Dose ◽

Dose Group ◽

Antimicrobial Prophylaxis ◽

Lumbar Spine Surgery ◽

Site Infection ◽

Control And Prevention

Object Antimicrobial prophylaxis (AMP) reduces the rate of surgical site infection (SSI) in lumbar spine surgery, but a great deal of variation exists regarding the timing and duration of AMP. The authors had previously used prophylactic antibiotics for 5 to 7 postoperative days. Based on the Centers for Disease Control and Prevention (CDC) guideline, the AMP period was changed to the day of surgery only. In the current study, the authors compared the rate of SSI in lumbar spine surgeries between two different protocols of AMP. Methods Data from 1597 consecutive uninfected patients who had undergone lumbar spine surgery between January 1999 and September 2004 were reviewed. The pathophysiologies among these patients included disc herniation in 686, degenerative spondylolisthesis in 340, spinal stenosis in 259, failed lumbar surgeries in 73, degenerative scoliosis in 52, isthmic spondylolisthesis in 48, spinal trauma in 34, foraminal stenosis in 27, spinal tumor in 27, and miscellaneous in 51 patients. The rate of SSI was compared between the two AMP groups. There were 1133 patients in the multiple-dose group, and 464 patients in the single-dose group. The rate of instrumentation surgery was not statistically different between the multiple-dose group (43%) and the single-dose group (39%). The overall rate of SSI was 0.7%. The SSI rate was 0.8% in the multiple-dose group and 0.4% in the single-dose group; the difference between the two was not significant. Regarding the organisms of SSI, resistant strains of bacteria were cultured in five (83.3%) of six patients in the multiple-dose group, whereas none was cultured in the single-dose group. Conclusions Data in the current study did not demonstrate a difference in the rate of SSI between the two different AMP protocols. Based on the CDC guideline, a single dose of AMP was proven to be efficacious for the prevention of SSI in lumbar spine surgeries. A shorter duration of first-generation cephalosporin use may effectively prevent the emergence of antibiotic-resistant bacterial infection.

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