title: Comparative study of epidural application of morphine versus gelfoam soaked in morphine for lumbar laminectomy.
abstract: BACKGROUND
  Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use.
  
  
  METHODS
  One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml) was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml) was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU) and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests.
  
  
  RESULTS
  Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg) as compared to group II (24.80 ± 6.009 mg). Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P < 0.001). Group I patients were discharged earlier from PACU as compared to group II (P < 0.001) though time of discharge from hospital was similar in both the groups. There were no major adverse effects except pruritis, which was observed in 30.6% patients in group I and 37.3% in group II (statistically insignificant (P > 0.01)).
  
  
  CONCLUSIONS
  Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.
authors.affiliation: Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Kundra
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Vishnu
authors.initials: V
authors.lastname: Gupta
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Hanish
authors.initials: H
authors.lastname: Bansal
authors.affiliation: Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Anju
authors.initials: A
authors.lastname: Grewal
authors.affiliation: Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Katyal
authors.affiliation: Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
authors.forename: Ashwini Kumar
authors.initials: AK
authors.lastname: Choudhary
keywords: Analgesia epidural; analgesics; laminectomy; opioid; pain; postoperative