title: [Clinical utility of epidural anesthesia during and after major spine surgery].
abstract: BACKGROUND
  Spine surgery causes severe postoperative pain, but epidural anesthesia is not commonly used. The main reason is that it might cause some complications, such as motor block and infection. We compared the efficacy of epidural infusion with hypodermic infusion.
  
  
  METHODS
  Thirty-two patients scheduled for spine surgery were included in the study. Patients were randomly assigned to receive either continuous epidural infusion (ropivacaine 0.18% and fentanyl 45.5 microg x ml(-1) at 2 ml x hr(-1)) or continuous hypodermic infusion via a patient-controlled analgesia system (morphine 0.04 mg x kg(-1) x ml(-1) at 0.5 ml x hr(-1); bolus: 0.5 ml x hr(-1)). We investigated pain and nausea by using visual analogue scale after surgery.
  
  
  RESULTS
  Patient data did not differ between groups. Pain and nausea scores were significantly lower in the epidural infusion group than in the hypodermic infusion group. Epidural infusion did not cause any complications. The incidence of nausea in the hypodermic infusion group was 13 times as high as that in the epidural infusion group. Similarly, the incidence of nausea in female patients was 13 times as high as that in male patients.
  
  
  CONCLUSIONS
  Continuous epidural infusion provides superior analgesia even if high-dose local anesthetics are not used. Besides, it decreases the incidence of nausea because systemic administration of opioids can be avoided.
authors.affiliation: Department of Anesthesia, Keiyu Hospital, Yokohama 220-8521.
authors.forename: Makoto
authors.initials: M
authors.lastname: Ukita
authors.forename: Masato
authors.initials: M
authors.lastname: Sato
authors.forename: Kimiyasu
authors.initials: K
authors.lastname: Sato
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Fukuya
authors.forename: Mitsuhiko
authors.initials: M
authors.lastname: Yoneyama
authors.forename: Takahiro
authors.initials: T
authors.lastname: Sakuma
authors.forename: Junichi
authors.initials: J
authors.lastname: Masuda
mesh_terms: D000368:Aged; D000577:Amides / Q000008:administration & dosage; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000779:Anesthetics, Local / Q000008:administration & dosage; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007262:Infusions, Intravenous; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011446:Prospective Studies; D000077212:Ropivacaine; D013131:Spine / Q000601:surgery*
chemical_list: D000577:Amides; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl