KINETIC AND KINEMATIC ANALYSES DURING GAIT FOLLOWING EPIDURAL ANALGESIA.

Abstract

Studies have shown significantly shorter hospital stays and earlier return to mobilization when epidural analgesia was used in lower extremity surgeries. This study quantified the effects of epidural analgesia on lower extremity kinetics and kinematics during gait. There were no significant differences found in hip, knee, or ankle joint moments or angles between baseline (no drug) and epidural trials, using two different drugs. These findings indicate that epidural analgesia does not alter normal gait in healthy subjects, suggesting that patients requiring epidural analgesia following orthopaedic surgery may also be able to participate in rehabilitation without significant epidural-related changes in gait.

Epidural analgesia has been used post-operatively following chest, abdominal and lower extremity surgery, with significantly shorter hospital stay and earlier return to mobilization demonstrated. This study quantified the effects of epidural analgesia on lower extremity kinetics and kinematics during gait.

Ten healthy volunteers were tested on different days with two drugs. With the catheter (L3-L4 intervertebral space) in place but prior to drug administration, gait was assessed. Testing was repeated 30 min after drug administration. Motion and ground reaction force data were recorded during walking with a four-camera video-based system (Motion Analysis Corp) and force platform (Kistler).

No significant differences existed in 3-D hip, knee, or ankle joint moments or angles among baseline (no drug) and drug trials.

These findings indicate that epidural analgesia does not alter normal gait in healthy subjects, suggesting that patients requiring epidural analgesia following orthopaedic surgery may also be able to participate in rehabilitation without significant epidural-related changes in gait.

It is well documented that early mobilization and rehabilitation following orthopaedic surgery improve healing and shorten hospital stay. However, pain often limits full participation. Epidural analgesia appears to be an appropriate mode of pain relief that, despite somatosensory changes, may allow normal gait.

Epidural analgesia in healthy volunteers does not alter lower extremity kinetics or kinematics, suggesting that it may be an effective mode of pain relief that will allow better participation in therapy following orthopaedic surgery.

Funding: McCaig Professorship Program Development Fund, Wood Professorship, The Foothills Hospital Obstetric Anesthesia Research Fund, The National Science and Engineering Research Council of Canada, and The University of Calgary Biomedical Engineering Program.