Efficacy of sacral epidural blockade with bupivacaine versus morphine as pre-emptive analgesia for lumbar laminectomy surgeries

Eid Mansy Mohammed Hussien, Gihan Seif El Nasr Mohammed, Ahmed Nagah Elhassanin El Shaer, Abdelaziz Abdallah Abdelaziz, Assem Adel Moharram

Ain-Shams Journal of Anaesthesiology 2016 9(2):260-266

Objectives Patients undergoing lumbar laminectomy experience severe pain in the postoperative period, which may increase the incidence of postoperative morbidity and complications. Adequate pain relief hastens rehabilitation and decreases the incidence of chronic pain. This study was designed to compare the efficacy of pre-emptive image-guided caudal epidural blockade with bupivacaine at low concentrations versus morphine administration on the attenuation of the stress response during and after lumbar laminectomy surgeries. Patients and methods Ninety adult American Society of Anaesthesiologists' physical status I and II patients were scheduled to undergo a single-level lumbar laminectomy and were administered a pre-emptive caudal injection of either 30 ml of bupivacaine 0.125% (group A) or 50 mg/kg preservative-free morphine added to a total dose of 30 ml saline (group B) or 30 ml saline (group C). Intraoperative vital data (heart rate, systolic, and diastolic blood pressure) were collected. The postoperative verbal rating scale score, the time of the first rescue analgesia, the total dose of rescue analgesia, and adverse effects were recorded for all patients in the first 24 h after surgery. Results The total verbal rating scale score and the need for rescue analgesia were significantly less in group A and group B than in group C, indicating better analgesia. There was no significant difference between the three groups in itching or the sedation score. Group C had a higher incidence of vomiting than groups A and B, whereas there was delayed ambulation in group A in comparison with the other groups. Conclusion A single caudal epidural injection of morphine is a safe, simple, and effective technique that provides prolonged postoperative duration of analgesia with fewer analgesic requirements postoperatively with earlier patients' ambulation without occurrence of any hemodynamic changes or increased incidence of adverse effects in lumber laminectomy surgeries.

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