medigraphic.com
ISSN 2992-7749 (Electronic)
ISSN 2992-7897 (Print)
Órgano Oficial de difusión científica de la Asociación Mexicana de Cirujanos de Columna A. C.

2026, Number 2

<< Back Next >>

Cir Columna 2026; 4 (2)

Caudal epidural analgesia for postoperative pain management in lumbar spine surgery: a series of 20 cases

Cruz ÁMG, Guerrero MAL, García LOF

Language: Spanish
References: 15
Page: 85-90
PDF size: 519.98 Kb.


ABSTRACT

Introduction: lumbar spine surgery, including discectomy, laminectomy, fusion, and instrumentation, is among the most painful surgical procedures, with postoperative pain often causing delays in recovery and increased healthcare costs. Adequate analgesia promotes early mobilization, reduces complications, and accelerates hospital discharge. Multimodal strategies, including paracetamol, NSAID, and opioids, have demonstrated efficacy; however, evidence regarding the role of caudal epidural block in lumbar surgery is limited. This procedure, described in the early 20th century and enhanced with fluoroscopic or ultrasound guidance, appears as a safe and effective alternative for postoperative pain management. Objective: to present our institution's experience and evaluate the efficacy of caudal block with ropivacaine and methylprednisolone as an analgesic strategy in patients undergoing lumbar spine surgery with lateral lumbar interbody fusion (XLIF) and pedicle screw instrumentation. Material and methods: a case series of 20 patients aged 45-65 years, classified as ASA II and presenting with severe preoperative pain (VAS 7-10) despite conventional analgesia, was conducted. The caudal block was administered using 30 mg of ropivacaine and 40 mg of methylprednisolone in 20 ml of saline, guided by ultrasound in 12 patients and fluoroscopy in 8. All patients received standard monitoring, supplemental oxygen, and intravenous fentanyl to facilitate positioning. Results: after the block, four patients (20%) achieved a VAS score of 0/10, while the remaining patients reported tolerable pain during ambulation (VAS 3/10), allowing safe same-day discharge. No significant differences were observed between guidance techniques, and no complications occurred within the first 24 hours. Discussion: these findings confirm that caudal block with ropivacaine and methylprednisolone is effective and safe, supporting multimodal analgesia and facilitating early recovery. Ultrasound guidance provides a radiation-free alternative with efficacy comparable to fluoroscopy. The main limitations of the study include the small sample size and short follow-up, which limit evaluation of prolonged analgesia and late complications. Conclusions: caudal epidural block is a promising strategy for postoperative pain management in lumbar spine surgery, providing effective analgesia, early mobilization, and safe discharge. Prospective studies with larger patient cohorts and extended follow-up are needed to consolidate its use within multimodal analgesia protocols.


REFERENCES

  1. Vilchis-Sámano H, Villegas-Esquivel EL, Muñiz-Luna L, Luna-Alonso Y. Manejo analgésico en cirugía de columna lumbar. Rev Mex Anestesiol. 2019; 42: 205. Disponible en: https://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0484-79032019000300205

  2. Alvarez-Galovich L, Ley Urzaiz L, Martín-Benlloch JA, Calatayud Pérez J. Recommendations for enhanced post-surgical recovery in the spine (REPOC). Rev Esp Cir Ortop Traumatol. 2023; 67: T83-T93. doi: 10.1016/j.recot.2022.12.014.

  3. Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. J Spine Surg. 2019; 5: S154-S159. doi: 10.21037/jss.2019.05.04.

  4. Esteve-Pérez N, Sansaloni-Perelló C, Verd-Rodríguez M, Ribera-Leclerc H, Mora-Fernández C. Nuevos enfoques en el tratamiento del dolor agudo postoperatorio. Rev Soc Esp Dolor. 2017; 24: 132-139. doi: 10.20986/resed.2017.3542/ 2016.

  5. Waelkens P, Alsabbagh E, Sauter A, Joshi GP, Beloeil H; PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (ESRA). Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations. Eur J Anaesthesiol. 2021; 38: 985-994. doi: 10.1097/EJA. 0000000000001448.

  6. Cirenei C, Boussemart P, Leroy HA, Assaker R, Tavernier B. Effectiveness of bilateral ultrasound-guided erector spinae plane block in percutaneous lumbar osteosynthesis for spine trauma: a retrospective study. World Neurosurg. 2021; 150: e585-e590. doi: 10.1016/j.wneu.2021.03.068.

  7. European Society of Regional Anaesthesia and Pain Therapy (ESRA). Summary recommendations: complex spine surgery. 2020. Available in: https://esraeurope.org/wp-content/uploads/2021/01/Summary-recommendations_Complex-spine-surgery_2020_ES.pdf

  8. Guay J, Suresh S, Kopp S, Johnson RL. Postoperative epidural analgesia versus systemic analgesia for thoraco-lumbar spine surgery in children. Cochrane Database Syst Rev. 2019; 1: CD012819. doi: 10.1002/14651858.CD012819.pub2.

  9. Cortiñas-Sáenz M, Iglesias-Cerrillo JA, Cano-Navarro G, Salmerón-Cerezuela J, Quirante-Pizarro A, Carricondo-Martínez MI. et al. Bloqueo caudal en dolor crónico lumbar: ¿es necesario el apoyo radiológico para disminuir los fallos de la técnica? Rev Soc Esp Dolor. 2012; 19: 184-192. Disponible en: https://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1134-80462012000400003

  10. Kao SC, Lin CS. Caudal epidural block: An updated review of anatomy and techniques. Biomed Res Int. 2017;2017:9217145. doi: 10.1155/2017/9217145.

  11. Álvarez CA, Rivera DRC, Arcila LMA. Eficacia de la metilprednisolona epidural en el dolor radicular. Colomb J Anesthesiol. 2015; 43: 61-67. doi: 10.1016/j.rca.2014.09.001.

  12. Ranguis SC, Li D, Webster AC. Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease: A review. J Neurosurg Spine. 2010; 13: 745-757. doi: 10.3171/2010.6.SPINE09796.

  13. Manchikanti L, Buenaventura RM, Manchikanti KN, Ruan X, Gupta S, Smith HS, et al.. Effectiveness of therapeutic lumbar transforaminal epidural steroid injections in managing lumbar spinal pain. Pain Physician. 2012; 15: E199-E245.

  14. Ehsanian R, Kadaba V, Saffarian M, Levi D; International Pain and Spine Intervention Society's Patient Safety Committee. FactFinders for patient safety: preservative vs. preservative-free: Steroid choice for epidural injections. Int Pain Spine Interv Soc. 2025. Disponible en: https://ipsis.org/factfinders

  15. Guler A, Senol YC, Akpinar AE, Gunerhan G, Dalgic A. Comparison of the particulate steroids, betamethasone and methylprednisolone, in caudal steroid injection under ultrasound guidance. World Neurosurg. 2023; 178: e421-e426. doi: 10.1016/j.wneu.2023.07.083




2020     |     www.medigraphic.com