Post-operative Epidural Analgesia After Minimally Invasive Lumbar Decompression and Fusion

Post-operative Epidural Analgesia After Minimally Invasive Lumbar Decompression and Fusion

Minimally invasive (MIS) lumbar decompression and fusion is a new procedure that aims to reduce post-operative pain, opioid consumption and related side effects, and length of hospital stay. Current research demonstrates a modest improvement in these areas beginning on the third post-operative day. MIS fusion, however, incurs significant cost as the average time of the procedure is approximately one third greater (from 148 minutes to 191 on average). Epidural analgesia has clearly demonstrated benefits for conventional open laminectomy. In order to fully maximize the benefits of an MIS technique, early post-operative analgesia/pain must be improved. The aim of this study is to combine two techniques to ultimately improve patient outcomes and satisfaction. This will be a randomized trial involving 32 patients undergoing MIS decompression and fusion with half the study group receiving active epidural and IV-PCA and the other half receiving epidural placebo and IV-PCA.

The hypothesis is that epidural analgesia will reduce post-operative opioid consumption, improve pain scores, and decrease time to ambulation as well as discharge from hospital after MIS decompression and fusion.

Inclusion Criteria:

• patients scheduled to undergo minimally invasive lumbar decompression and fusion at the Toronto Western Hospital
• both genders
• ASA I to III
• BMI less than 35

Exclusion Criteria:

• refuses treatment randomization
• inability to give informed consent
• language barrier
• local anesthetic allergy
• allergy to shellfish or eggs
• bleeding diathesis
• sickle cell disease or trait
• pregnancy
• drug addiction
• psychiatric history
• severe intercurrent illness (ASA IV or V)
• patients requiring anesthesia of other surgical sites