Epidural Analgesia Versus IV Analgesia in Lumbar Spine Fusions

January 10, 2017 updated by: Duke University

A Comparison of Epidural Analgesia With Standard Care Following Lumbar Spinal Fusion: A Prospective Randomized Study

  1. Protocol Title - A Comparison of Epidural Analgesia with Standard Care Following Lumbar Spinal Fusion: A Prospective Randomized Study
  2. Purpose of the Study - This prospective randomized study will enroll 200 patients undergoing elective Lumbar Spinal Fusion at Duke University Hospital. The primary objective is to determine the effect of epidural analgesia, as compared with standard care, on post-operative analgesia.

Hypothesis:

The investigators hypothesize that patients undergoing Lumbar Spinal Fusion surgery with epidural catheter placement will have superior post-operative analgesia compared to patients undergoing standard care.

Study Overview

Status

Terminated

Conditions

Intervention / Treatment

Study Type

Interventional

Enrollment (Actual)

17

Phase

  • Phase 3

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • North Carolina
      • Durham, North Carolina, United States, 27710
        • Duke University Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Adult patients who are scheduled for elective Transforaminal Lumbar Interbody Fusion surgery

Exclusion Criteria:

  • Baseline cognitive deficits sufficient to make objective pain self-assessments unreliable in the estimation of the Study Investigators.
  • Inability to follow directions or comprehend the English language.
  • Females who are pregnant as determined by positive pregnancy test on or before the day of surgery.
  • Prisoners.
  • Patient refusal to provide informed consent.
  • Allergy to amide local anesthetics (lidocaine, bupivacaine, ropivacaine).

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Treatment
  • Allocation: Randomized
  • Interventional Model: Parallel Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Experimental: Intravenous opioids
This is the standard of care method for post-operative analgesia following lumbar spine fusion surgery. Participants randomly assigned to this arm will receive Intravenous Patient-Controlled Analgesia (IVPCA) with dilaudid (or other opioid) for post-operative pain control.
Drug: Dilaudid
Patients in this arm will receive intravenous patient-controlled opioid analgesia (Dilaudid).
Experimental: Epidural Catheter
The intervention to be tested in this study against standard intravenous opioids is infusion of local anesthetic and dilaudid via epidural catheter for post-operative pain control in patients undergoing lumbar spine fusion surgery.
Other: Epidural Catheter - Dilaudid
Placement of an epidural catheter to administer local anesthetic and opioid (dilaudid) to the epidural space will be studied as compared to use of intravenous opioid (dilaudid) for pain control following lumbar spine fusion surgery.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Post-operative Pain as Assessed by Visual Analogue Scale (VAS)
Time Frame: Postoperative day 1
The VAS scale ranges from 0 to 100 mm with the lower score indicating less pain and the higher score indicating greater pain.
Postoperative day 1

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Patient Satisfaction With Perioperative Analgesia
Time Frame: Post-operative Day 1
Patients will be assessed for satisfaction with their peri-operative analgesia in the recovery room and each day of their epidural infusion or intravenous opioid infusion by the Acute Pain Service, and at their surgical follow-up visit. Likert scale ranges from 1 to 5 (1=very satisfied and 5=Very Dissatisfied).
Post-operative Day 1
Patient Satisfaction With Perioperative Analgesia
Time Frame: 6-Week Follow up Visit
Patients will be assessed for satisfaction with their peri-operative analgesia in the recovery room and each day of their epidural infusion or intravenous opioid infusion by the Acute Pain Service, and at their surgical follow-up visit. Likert scale ranges from 1 to 5 (1=very satisfied and 5=Very Dissatisfied).
6-Week Follow up Visit
Patient Satisfaction With Overall Care
Time Frame: 6-Week Follow up Visit
Likert scale ranges from 1 to 5 (1=very satisfied and 5=Very Dissatisfied).
6-Week Follow up Visit
Number of Participants With Events of Special Interest
Time Frame: Post-operative Day 30
Patients will be assessed for development of a deep vein thrombosis after surgery, and surgical site infection.
Post-operative Day 30
Number of Participants With Adverse Events Related to the Study
Time Frame: 6-week Follow up Visit
Patients will be assessed in the recovery room and each day of their epidural or intravenous opioid infusions, and at their surgical follow-up visit.
6-week Follow up Visit
Total Post-operative Opioid Consumption
Time Frame: during hospitalization (approximately 3-8 days)
during hospitalization (approximately 3-8 days)
Number of Participants Experiencing Delirium
Time Frame: Post-operative Day 1
Post-operative Day 1
Number of Participants Experiencing Delirium
Time Frame: Post-operative Day 2
Post-operative Day 2
Number of Participants Experiencing Delirium
Time Frame: Post-operative Day 3
Post-operative Day 3
Number of Participants Readmitted to Hospital Within 30 Days of Surgery
Time Frame: Post-operative Day 30
Post-operative Day 30
Length of Hospital Stay
Time Frame: during hospitalization (approximately 3-8 days)
during hospitalization (approximately 3-8 days)
Wound Infection Rates
Time Frame: during hospitalization (approximately 3-8 days)
during hospitalization (approximately 3-8 days)

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Duke University

Investigators

  • Principal Investigator: Erin L Manning, MD/PhD, Duke University Hospital Department of Anesthesiology
  • Principal Investigator: Carlos Bagley, MD, Duke University Hospital Department of Neurosurgery

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

October 1, 2013

Primary Completion (Actual)

September 1, 2015

Study Completion (Actual)

September 1, 2015

Study Registration Dates

First Submitted

January 3, 2013

First Submitted That Met QC Criteria

November 12, 2013

First Posted (Estimate)

November 19, 2013

Study Record Updates

Last Update Posted (Actual)

February 23, 2017

Last Update Submitted That Met QC Criteria

January 10, 2017

Last Verified

January 1, 2017

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

  • Pro00041252

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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