Stroke Volume Variation-Guided Fluid Management Decreased Postoperative Pain in Patients Undergoing Spine Surgery

Authors:

Chen WY^1,3*, Chia YY^1,2,3 and Lo Y^1,2,3

Volume 1, Issue 2

Abstract

Background: This study was to evaluate whether stroke volume variation (SVV)-guided fluid management would improve postoperative pain perception, plasma lactate and glucose levels, in-hospital mortality and morbidity, and length of hospital stay, when compared with those guided by central venous pressure (CVP).
Methods: Ninety-one patients scheduled for major lumbar spine surgery were randomized into two groups; SVV-guided and CVP-guided groups. Fluid management for the SVV-guided group was based on the SVV and stroke volume index level and the CVP-guided group was based upon the CVP. Repeated boluses of 5 mL/kg crystalloid was given to keep the SVV less than 13% or CVP between 8-13 mmHg, and bolus ephedrine 5 mg was administered to keep the mean blood pressure greater than 65 mmHg. Plasma lactate, glucose, electrolytes, hemoglobin levels, hemodynamic values, and postoperative major and minor complications were recorded. Postoperative pain intensity on movement was the primary outcome; morphine consumption and perioperative lactate levels were the secondary targets.
Results: Lactate and glucose levels in both intraoperative and postoperative periods were lower in the SVV than CVP group (p < 0.05). Both pain intensities during movement and at rest were significantly lower in the SVV than CVP group; the trend lasted for three days postoperatively (p < 0.05) although the difference between groups did not be found regarding to the postoperative morphine consumption. The hospital stay was significantly longer in the CVP than SVV group (p < 0.05).
Conclusion: SVV-guided fluid management resulted in an improved control of serum lactate and glucose level than in those CVP-guided patients. Three-day postoperative pain intensities and length of hospital stay were significantly lower and shorter, respectively, in the SVV-guided fluid management than in those with CVP-guided. The results suggest using reasonably SVV-guided fluid strategy for major spine surgery may get relatively better postoperative pain, lactate, and glucose control.

Keywords:

Pain; Analgesia, Patient-controlled analgesia; Stroke volume variation; Central venous pressure; Fluid management

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