Volume 1, Issue 1 (6-2015)                   IrJNS 2015, 1(1): 28-34 | Back to browse issues page

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Ashraf A, Khanjanian G, Yousefzadeh-Chabok S, Alijani B, Ebrahimpour N, Chavoshi T. Comparison of Analgesic Effects of Epidural Infusion of Fentanyl and Fentanyl-bupivacaine in Spine Surgery: A Randomized Clinical Trial Study. IrJNS. 2015; 1 (1) :28-34
URL: http://irjns.org/article-1-3-en.html
1- , draliashraf@yahoo.fr
Abstract:   (1389 Views)

Background & Aim: Although most patients experience severe pain after major spinal fixation surgery, little attention has been paid to control it with a multi-modal approach. The aim of this study is to select appropriate method of pain management after spinal surgery. Methods &

Materials/Patients: This study was a randomized clinically controlled trial in candidates of spondylolisthesis and spinal fixation surgery under general anesthesia. 90 patients were divided into three groups, as follows: 1) Intervention group of epidural fentanyl (F): patient-controlled analgesia (PCA) pump infused 100 µg of fentanyl and 98cc of normal saline at the rate of 3-5 ml/h in the epidural space via an epidural catheter placed by surgeon 2) Intervention group of epidural fentanyl-bupivacaine (FB): PCA pump infused 100 µg of fentanyl and bupivacaine 0.125% at the rate of 3-5 ml/h in the epidural space. 3) IV morphine group (M): No medication was received epidurally. In case of visual analog scale (VAS) score more than four, one mg of IV morphine bolus was administered to patient. The blood pressure, heart rate, respiratory rate and pain severity were recorded at the moment of patient’s transfer from recovery room to the ward and compared in three groups every six hours for 24 hours. The results of this study were analyzed by statistical tests including repeated measures ANOVA, Kruskal-Wallis, Fisher’s exact test and SPSS software 16. P values less than 0.05 were considered statistically significant.

Results: The results of the study showed that VAS score in fentanyl-bupivacaine group was significantly lower than that in the two other groups during the first 18 hours. However, VAS score in all groups decreased at 24th hour postoperatively (less than three) suggesting that there was no statistically significant difference between the three groups. In this study, no serious and severe complications were observed except for a few cases of nausea in the control group.

Conclusion: Epidural analgesia with fentanyl-bupivacaine is a safe and effective way to postoperative pain management in listhesis and spinal surgeries.  

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Type of Study: Research |

1. Bianconi M, Ferraro L, Ricci R, et al. The pharmacokinetics and efficacy of ropivacaine continuous wound installation after spine fusion surgery. Anesth Analg. 2004;98:166 –72
2. Michael R. Schenk, Michael Putzier, Bjoern Ku¨ gler and et al. Postoperative Analgesia After Major Spine Surgery: Patient-Controlled Epidural Analgesia Versus Patient-Controlled Intravenous Analgesia: Anesth Analg. 2006;103:1311–17.
3. Gottschalk A, Freitag M, Tank S, et al. Quality of postoperative pain using an intraoperatively placed epidural catheter after major lumbar surgery. Anesthesiology. 2004;101:175– 80.
4. Blumenthal S, Min K, Nadig M, Borgeat A. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology. 2005;102:175– 80.
5. Eilers K, Schenk M, Putzier M, et al. Use of peridural catheters in the treatment of postoperative pain after spinal instrumented fusion–an experience report. Z Orthop Ihre Grenzgeb. 2002;140: 621–5.
6. Sang Hoon Lee, Kyung Hyun Kim, Seong-Mee Cheong,et al; A Comparison of the Effect of Epidural Patient-Controlled Analgesia with Intravenous Patient- Controlled Analgesia on Pain Control after Posterior Lumbar Instrumented Fusion: J Korean Neurosurg, 2011: 50 : 205-208.
7. Lebovits AH, Zenetos P, O’Neill DK, Cox D, Dubois MY, Jansen LA, et al. Satisfaction with epidural and intravenous patient-controlled analgesia. Pain Med. 2001;2:280–286.
8. Teng YH, Hu JS, Tsai SK, Liew C, Lui PW. Efficacy and adverse effects of patient-controlled epidural or intravenous analgesia after major surgery. Chang Gung Med J. 2004;27:877–886.
9. Kumar RJ, Menon KV, Ranjith TC. Use of epidural analgesia for pain management after major spinal surgery. Journal of Orthopaedic Surgery. 2003:11(1): 67–72.
10. Cata JP, Noguera EM, Parke E, Ebrahim Z, Kurz A, Kalfas I, et al. Patient-controlled epidural analgesia (PCEA) for postoperative pain control after lumbar spine surgery. J Neurosurg Anesthesiol 2008;20: 256- 260.
11. Fisher CG, Belanger L, Gofton EG, Umedaly HS, Noonan VK, Abramson C, et al. Prospective randomized clinical trial comparing patient-controlled intravenous analgesia with patient-controlled epidural analgesia after lumbar spinal fusion. Spine. 2003;28:739-743.
12. Van Boerum DH, Smith JT, Curtin MJ. A comparison of the effects of patient-controlled analgesia with intravenous opioids versus epidural analgesia on recovery after surgery for idiopathic scoliosis. Spine. 2000;25:2355-2357.
13. Lowry KJ, Tobias J, Kittle D, Burd T, Gaines RW. Postoperative pain control using epidural catheters after anterior spinal fusion for adolescent scoliosis. Spine. 2001;26:1290–3.
14. Cassady JF Jr, Lederhaas G, Cancel DD, et al. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med. 2000;25:246 –53.
15. Shaw BA, Watson TC, Merzel DI, et al. The safety of continuous epidural infusion for postoperative analgesia in pediatric spine surgery. J Pediatr Orthop. 1996;16:374 –7.
16. Cohen BE, Hartman MB, Wade JT, et al. Postoperative pain control after lumbar spine fusion. Patient-controlled analgesia versus continuous epidural analgesia. Spine. 1997;22:1892–7.
17. Haitham Abou Zeid, Ahsan Khaliq Siddiqui, Ehab F. A. Elmakarem, Yasser Ghonaimy, Awatif Al Nafea, Comparison between intrathecal morphine with paravertebral patient controlled analgesia using Bupivacaine for intraoperative and post-thoracotomy pain relief. Saudi journal of anaesthesia 07/2012; 6(3):201-6. DOI: 10.4103/1658-354X.101204

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