Mehmet Alpay ÇAL, Ahmed Yasin YAVUZ
Journal of Turkish Spinal Surgery - 2026;37(4):155-164
Objective: Preemptive analgesia may reduce early postoperative pain after lumbar microdiscectomy, but the optimal anatomical target for local anesthetic delivery remains unclear. This study compared pre-incisional caudal epidural analgesia (pre-CEA) with pre-incisional local surgical-site infiltration (pre-LSSI) for single-level lumbar microdiscectomy. Materials and Methods: This retrospective comparative cohort study analyzed prospectively recorded perioperative pain data from adults undergoing single-level lumbar microdiscectomy in 2022. Analgesic protocols were not randomized; patients selected pre-LSSI, pre-CEA, or no preemptive analgesia after preoperative discussion. The primary analysis compared pre-LSSI with pre-CEA; the control cohort was exploratory. The primary outcome was the 24-hour visual analog scale (VAS)-back area under the curve (AUC). Secondary outcomes included VAS-leg AUC, rescue analgesia, opioid rescue, ambulation time, length of stay, and adverse events. Results: The study included 138 patients: 47 pre-LSSI, 42 pre-CEA, and 49 controls. VAS-back AUC was lower with pre-CEA than pre-LSSI (42.2 +/-8.0 vs. 64.0 +/-6.0; p<0.001), as was VAS-leg AUC [0.0 (0.0-0.0) vs. 8.0 (8.0-8.0); p<0.001]. Rescue analgesia was required in all pre-LSSI patients but in none of the pre-CEA patients (p<0.001). Neither active-treatment group required opioid rescue. Conclusion: Pre-CEA was associated with lower early postoperative pain burden and no rescue analgesic requirement during the first 24 hours compared with pre-LSSI. Given the preference-based, non-randomized design and non-equivalent bupivacaine protocols, prospective, randomized, dose-standardized studies are needed to confirm these findings.
