Joseph Akhil Xavier, Vidyadhara Alia, Kashyap Anjana, Soni Abhishek, Thirugnanam Balamurugan, Pai Madhava, S Vidyadhara
Manipal Comprehensive Spine Care Centre, Bangalore, India.
Manipal Hospital, Bengaluru, India.
Eur Spine J. 2025 Aug;34(8):3106-3112. doi: 10.1007/s00586-025-09143-x. Epub 2025 Jul 14.
Effective 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.
To evaluate and compare pain control efficacy, recovery outcomes, and postoperative complications between IV and epidural preemptive analgesia routes in lumbar spine surgeries.
A 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.
VAS 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).
This 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 IV.
腰椎手术中有效的疼痛管理对于促进术后恢复和减少并发症至关重要。静脉注射或硬膜外给予的超前镇痛在控制疼痛方面已显示出前景；然而，直接比较这两种途径以确定腰椎手术最佳方法的数据有限。
评估和比较腰椎手术中静脉注射和硬膜外超前镇痛途径在疼痛控制效果、恢复结果和术后并发症方面的差异。
一项前瞻性、双盲研究，比较静脉注射（IV）和硬膜外超前镇痛在接受腰椎手术患者中的效果。接受腰椎手术的患者根据镇痛途径分为三组：硬膜外组、静脉注射组和对照组。术后评估疼痛评分、镇痛药物消耗量和恢复情况。采用包括方差分析和卡方检验在内的统计分析方法评估组间疼痛控制和恢复结果的差异。
术后4、8、12和24小时的视觉模拟评分（VAS）在组间有显著差异（p < 0.0001）。第一组（硬膜外组）报告的评分分别为5.13±0.86、4.97±0.93、3.23±0.94和3.17±0.91；第二组（静脉注射组）：6.79±1.29、5.07±0.92、3.79±1.18和3.21±0.94；第三组（对照组）：8.92±0.84、6.96±0.84、5.82±0.81和5.55±0.50。首次使用镇痛药物的时间分别为26.00±9.77分钟（第一组）、25.00±9.82分钟（第二组）和10.41±3.51分钟（第三组）（p < 0.0001）。24小时总消耗量：芬太尼——第一组：32.20±4.99微克，第二组：30.90±8.78微克，第三组：62.55±12.34微克；对乙酰氨基酚——1.00±0.00克、1.03±0.19克、2.00±0.00克；酮咯酸——50.00±0.00毫克、51.72±9.28毫克、100.00±0.00毫克；曲马多——45.00±15.26毫克、49.66±16.58毫克、73.47±15.08毫克（所有p < 0.0001）。
本研究通过直接比较腰椎手术中静脉注射和硬膜外超前镇痛填补了关键空白，为临床决策提供了见解。研究结果表明静脉注射镇痛在疼痛控制方面与硬膜外镇痛相当，是一种具有更少操作风险的更安全选择。结果对优化围手术期护理具有重要意义。
四级。
