The primary goal is to assess whether Lidocaine/IVPCA is better in morphine requirements and
simultaneously not worse in pain control measured by VAS pain score compared to IVPCA alone.
Participants undergoing spine surgery will be randomized into one of three groups;General 1)
Anesthesia and postoperative Patient Controlled Analgesia and placebo IV infusion,2) General
Anesthesia plus perioperative intravenous lidocaine infusion and post operative patient
controlled analgesia or 3) General Anesthesia plus postoperative epidural analgesia plus
placebo IV infusion.
After surgery, data will be collected including pain scores and narcotic and anesthesia
requirements. Incidents of complications related to surgery or pain medications will be
collected, such as bowel function, nausea and vomiting.
Inflammatory mediators will be evaluated in all groups to determine anti-inflammatory
- 18 to 80 years old at time of surgery - adult patients differ from pediatric patients
in that adult spines are stiffer than pediatric patient.
- Male or female patients undergoing complex spinal surgery using posterior approach
- Spine surgery only on the lumbar and thoracic regions - focused range of spinal
column with greater anticipated blood loss as compared to cervical spine surgery
(Fujita, 1998 - Complications of spinal fusion in adults greater than 60 years old).
- Fusion requiring screws and instrumentation - high volume blood loss anticipated with
surgeries requiring fusion versus without fusion (Deyo,1992), and with
instrumentation versus without instrumentation.
- Surgery performed at Cleveland Clinic with informed consent signed prior to sedation
or anesthesia - consistent surgical team.
- Allergy or hypersensitivity to sufentanil, bupivacaine, morphine, or any component of
formulations - serious adverse reaction that requires surgery be discontinued.
- Current or recent drug abuse (within past 6 months) - alters post-operative
- Pregnancy - risks to fetus and mother potentially fatal.
- Immune system disease such as HIV, AIDS - alters measurement of inflammatory markers
and possible post-operative complications.
- Undergoing immunosuppressive treatment - alters measurement of inflammatory markers.
- Recent history of sepsis - alters measurement of inflammatory markers.
- Contraindications to lidocaine such as heart block and hepatic insufficiency.
- Heart failure with ejection fraction less than 30%.
- Liver dysfunction manifested with increased liver enzymes to double the normal and
INR of 2 or higher.
Ehab Farag, MD
The Cleveland Clinic
Gretchen Upton, BA,CCRP