A Randomized controlled trial using epidural Analgesia for Pain relief after lumbar Interlaminar Decompressive spine surgery: the RAPID trial

STUDY DESIGN:Prospective, double blind randomized controlled trial. OBJECTIVE:If an intraoperative single bolus of epidural bupivacaine can result in less postoperative pain following lumbar spinal decompression surgery. SUMMARY OF BACKGROUND DATA:Adequate postoperative pain management following lumbar spinal decompression surgery is important as it will lead to early mobilization, less complications and shorter hospital stay. Opioid consumption should be limited due to their frequently accompanied side effects and their addictive nature. During the final phase of lumbar decompression surgery, the epidural space becomes easily accessible. This might be an ideal moment for surgeons to administer an epidural bolus of analgesia, as a safe and effective method for post-operative pain relief. METHODS:In this trial we compared a single intraoperative bolus of epidural analgesia using bupivacaine 0.25% to placebo (NaCl 0,9%) and its effect on postoperative pain following lumbar spinal decompression surgery. The primary outcome was the difference in NRS between the intervention and placebo groups during the first 48h after surgery. RESULTS:Both the intervention group and the placebo group consisted of 20 randomized patients (N=40). Statistically significant lower mean NRS pain scores were observed in the intervention group in comparison with the control group (main effect group: -2.35 (±0.77), P=0.004). The average pain score was lower in the intervention group at all postoperative time-points. No study related complications occurred. CONCLUSION:This randomized controlled trial shows that administrating a bolus of intraoperative epidural bupivacaine is a safe and effective method in reducing early postoperative pain following lumbar decompression surgery.