Perioperative Intravenous Lidocaine or Epidural Anesthesia on Outcomes in Complex Spine Surgery

According to a survey of 1570 U.S neurosurgeons, in the United States about 527.000 spine
surgeries were done in 1999. This represents close to 65% of the procedures performed by
neurosurgeons. Furthermore, the number of hospitalizations related with spine surgery has
significantly increased since 1970.

IV PCA is considered the standard of care for postoperative pain control after surgery.
Intravenous opioids have significant side effects such as respiratory depression,
postoperative nausea and vomiting and sedation. Furthermore, they cause delayed return of
bowel function and ileus.

There is the possibility of surgically inserting a catheter into the epidural space at the
end of surgery. In general epidural analgesia provides excellent pain relief after surgery
and decreases opioid consumption significantly und thus opioid related postoperative
complications. Furthermore epidural anesthesia affects the surgical stress response and
might decrease inflammatory responses after surgery, thereby improving postoperative
recovery and mobilization of the patients.

Intravenous local anesthetics have potent anti-inflammatory properties. They also decrease
postoperative opioid consumption. Clinical studies have shown that perioperative local
anesthetic administration significantly reduces the incidence of thrombosis and
postoperative pain, shortens postoperative ileus and decreases duration of hospitalization.

Therefore, the investigators will test the hypotheses that the use of IV lidocaine and
epidural decrease postoperative pain medication requirements and pain scores through POD 2
after spine surgery in patients using compared to the patients using IVPCA opioid only.