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

NCT ID: NCT00644111

Last Updated: 2013-02-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

32 participants

Study Classification

INTERVENTIONAL

Study Start Date

2008-02-29

Study Completion Date

2011-07-31

Brief Summary

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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.

Detailed Description

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Conditions

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Low Back Pain

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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1

Control group receiving saline placebo through an epidural catheter

Group Type PLACEBO_COMPARATOR

Saline Placebo

Intervention Type DRUG

Saline placebo continuous epidural infusion of 6 mL per hour in Arm 1

2

Experimental group receiving active medication through the epidural catheter

Group Type ACTIVE_COMPARATOR

Bupivicaine, Hydromorphone

Intervention Type DRUG

0.1% Bupivicaine with 0.015mg hydromorphone per mL at 6 mL per hour in Arm 2

Interventions

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Bupivicaine, Hydromorphone

0.1% Bupivicaine with 0.015mg hydromorphone per mL at 6 mL per hour in Arm 2

Intervention Type DRUG

Saline Placebo

Saline placebo continuous epidural infusion of 6 mL per hour in Arm 1

Intervention Type DRUG

Eligibility Criteria

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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
Minimum Eligible Age

18 Years

Maximum Eligible Age

80 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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University Health Network, Toronto

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Stephen Choi, MD

Role: PRINCIPAL_INVESTIGATOR

Resident Physician, Deparment of Anesthesia, University of Toronto

Richard T Brull, MD

Role: PRINCIPAL_INVESTIGATOR

Department of Anesthesia, University Health Network, Toronto Western Hospital

Yoga R Rampersaud, MD

Role: PRINCIPAL_INVESTIGATOR

Deparment of Surgery, Division of Orthopedics, University Health Network, Toronto Western Hospital

Vincent WS Chan, MD

Role: STUDY_DIRECTOR

Department of Anesthesia, University Health Network, Toronto Western Hospital

Paul S Tumber, MD

Role: STUDY_DIRECTOR

Department of Anesthesia, University Health Network, Toronto Western Hospital

Locations

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Toronto Western Hospital, University Health Network

Toronto, Ontario, Canada

Site Status

Countries

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Canada

References

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Kundra P, Gurnani A, Bhattacharya A. Preemptive epidural morphine for postoperative pain relief after lumbar laminectomy. Anesth Analg. 1997 Jul;85(1):135-8. doi: 10.1097/00000539-199707000-00024.

Reference Type BACKGROUND
PMID: 9212136 (View on PubMed)

Schenk MR, Putzier M, Kugler B, Tohtz S, Voigt K, Schink T, Kox WJ, Spies C, Volk T. Postoperative analgesia after major spine surgery: patient-controlled epidural analgesia versus patient-controlled intravenous analgesia. Anesth Analg. 2006 Nov;103(5):1311-7. doi: 10.1213/01.ane/0000247966.49492.72.

Reference Type BACKGROUND
PMID: 17056975 (View on PubMed)

Turner A, Lee J, Mitchell R, Berman J, Edge G, Fennelly M. The efficacy of surgically placed epidural catheters for analgesia after posterior spinal surgery. Anaesthesia. 2000 Apr;55(4):370-3. doi: 10.1046/j.1365-2044.2000.01117.x.

Reference Type BACKGROUND
PMID: 10781125 (View on PubMed)

Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, Collins KS; MASTER Anaethesia Trial Study Group. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002 Apr 13;359(9314):1276-82. doi: 10.1016/S0140-6736(02)08266-1.

Reference Type BACKGROUND
PMID: 11965272 (View on PubMed)

Gottschalk A, Freitag M, Tank S, Burmeister MA, Kreil S, Kothe R, Hansen-Algenstedt N, Weisner L, Staude HJ, Standl T. Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar spinal surgery. Anesthesiology. 2004 Jul;101(1):175-80. doi: 10.1097/00000542-200407000-00027.

Reference Type BACKGROUND
PMID: 15220788 (View on PubMed)

Blumenthal S, Min K, Nadig M, Borgeat A. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology. 2005 Jan;102(1):175-80. doi: 10.1097/00000542-200501000-00026.

Reference Type BACKGROUND
PMID: 15618801 (View on PubMed)

Ray CD, Bagley R. Indwelling epidural morphine for control of post-lumbar spinal surgery pain. Neurosurgery. 1983 Oct;13(4):388-93. doi: 10.1227/00006123-198310000-00007.

Reference Type BACKGROUND
PMID: 6633831 (View on PubMed)

Cohen BE, Hartman MB, Wade JT, Miller JS, Gilbert R, Chapman TM. Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia. Spine (Phila Pa 1976). 1997 Aug 15;22(16):1892-6; discussion 1896-7. doi: 10.1097/00007632-199708150-00016.

Reference Type BACKGROUND
PMID: 9280026 (View on PubMed)

Fisher CG, Belanger L, Gofton EG, Umedaly HS, Noonan VK, Abramson C, Wing PC, Brown J, Dvorak MF. Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine (Phila Pa 1976). 2003 Apr 15;28(8):739-43.

Reference Type BACKGROUND
PMID: 12698113 (View on PubMed)

Park Y, Ha JW. Comparison of one-level posterior lumbar interbody fusion performed with a minimally invasive approach or a traditional open approach. Spine (Phila Pa 1976). 2007 Mar 1;32(5):537-43. doi: 10.1097/01.brs.0000256473.49791.f4.

Reference Type BACKGROUND
PMID: 17334287 (View on PubMed)

Podichetty VK, Spears J, Isaacs RE, Booher J, Biscup RS. Complications associated with minimally invasive decompression for lumbar spinal stenosis. J Spinal Disord Tech. 2006 May;19(3):161-6. doi: 10.1097/01.bsd.0000188663.46391.73.

Reference Type BACKGROUND
PMID: 16770211 (View on PubMed)

Sandhu NS, Sidhu DS, Capan LM. The cost comparison of infraclavicular brachial plexus block by nerve stimulator and ultrasound guidance. Anesth Analg. 2004 Jan;98(1):267-268. doi: 10.1213/01.ANE.0000077685.55641.7C. No abstract available.

Reference Type BACKGROUND
PMID: 14693638 (View on PubMed)

Brull R, McCartney CJ, Chan VW, El-Beheiry H. Neurological complications after regional anesthesia: contemporary estimates of risk. Anesth Analg. 2007 Apr;104(4):965-74. doi: 10.1213/01.ane.0000258740.17193.ec.

Reference Type BACKGROUND
PMID: 17377115 (View on PubMed)

Foley KM. The treatment of cancer pain. N Engl J Med. 1985 Jul 11;313(2):84-95. doi: 10.1056/NEJM198507113130205.

Reference Type BACKGROUND
PMID: 2582259 (View on PubMed)

Pollard CA. Preliminary validity study of the pain disability index. Percept Mot Skills. 1984 Dec;59(3):974. doi: 10.2466/pms.1984.59.3.974. No abstract available.

Reference Type BACKGROUND
PMID: 6240632 (View on PubMed)

Choi S, Rampersaud YR, Chan VW, Persaud O, Koshkin A, Tumber P, Brull R. The addition of epidural local anesthetic to systemic multimodal analgesia following lumbar spinal fusion: a randomized controlled trial. Can J Anaesth. 2014 Apr;61(4):330-9. doi: 10.1007/s12630-014-0115-z. Epub 2014 Feb 12.

Reference Type DERIVED
PMID: 24519631 (View on PubMed)

Other Identifiers

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UHN 07-0736-A

Identifier Type: -

Identifier Source: org_study_id

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