A Randomized, Prospective, Blinded, Placebo Controlled Trial of Epidural Analgesia During Lumbar Discectomy

Todd S Crawford, MD
Patrick Tracy MD (Peoria, IL)
Debra Schulz RN, BSN, CNRN

Lumbar discectomy, primarily a pain procedure, has been modified and adapted to make patient's post operative recovery shorter and their satisfaction higher. Epidural analgesia is a mainstay of conservative therapy and its intraoperative use has been studied and used as an adjunct to surgery. We examined the effect of intraoperative epidural analgesia on pain and disability using a visual analogue scale and the Oswestry disability scale. Patients undergoing first time operations for radiculopathy due to herniated intervertebral discs were randomly administered either morphine 4 mg, bupivicaine 0.25% 6cc, solumedrol 80 mg or placebo (saline). The medication was placed in the epidural space following standard lumbar discectomy. The VAS and Oswestry scores were recorded preoperatively, and at one day, one week, one month, and three months postoperatively. A Kruskal–Wallis one–way analysis of variance was used for statistical analysis. Thirty patients were enrolled into the study. Demographics were similar in each group. There were no complications or adverse events. The mean preoperative VAS and Oswestry scores were similar for all groups (7.9 and 49%, respectively). As a whole, there was a statistically significant improvement from preop to post operative scores at each time point. However, amongst groups, there was no statistically significant improvement at any time point. We failed to prove any benefit to using intraoperative analgesia during routine lumbar discectomy.