Intra-Operative Epidural Anesthetic Injection for Control of Immediate Post-Operative Pain in PACU After Lumbar Spinal Surgery

Fred H. Geisler

Lumbar surgery patients often develop severe low back spasms immediately after emerging from anesthesia in the PACU and often require IV narcotics. This severe operative site pain can take hours to several days to resolve. It often causes the patient significant discomfort and can delay discharge, especially from planned outpatient surgery. These post-operative muscle spasms and/or operative site pain in the PACU have been considered inevitable consequences of lumbar surgery for most patients.

A retrospective chart review of 168 consecutive decompressive and/or in situ arthrodesis lumbar surgeries compared the use (n=133) or not (n=35) of a single epidural injection. The PACU pain response and narcotic use following a single epidural injection of 2 cc Fentanyl and 8 cc of ¼% Marcaine epidural medication given near the end of wound closure via an epidural catheter inserted intraoperatively were investigated and compared against similar patients not receiving an epidural injection.

The maximum pain score recorded in the PACU was 5.3/10 without the epidural injection and 1.7/10 with the injection (p<0.0001). The percentage of patients with no lumbar pain (0/10 pain score) at any time in the PACU was 20% for the group without the epidural injection and 65% for the group with the injection (p<0.0001).

The number of patients requiring IV or IM narcotics (83% versus 22%) and the number of doses (1.8 versus 0.3) for the groups without and with the epidural injection respectively were both statistically significant (p<0.0001). There were no complications related to the use of the epidural injection noted.

Intra-operative single epidural injection appears safe and effective in post-operative pain management after lumbar surgery in the PACU by significantly decreasing both the initial post-operative site pain and lumbar muscle spasms as the patients emerge from general anesthesia.