title: The influence of postoperative epidural analgesia on postoperative pain and stress response after major spine surgery--a randomized controlled double blind study.
abstract: Major spinal surgery is associated with severe postoperative pain and stress response, bowel dysfunction, and a potential for chronic pain development. Epidural analgesia has been shown to be advantageous compared to intravenous analgesia alone. The aim of the study was to investigate whether postoperative addition of epidural levobupivacaine to intravenous opioid analgesia offers advantage over intravenous opioid analgesia alone. Eighty-one patients scheduled for spinal fusion were enrolled in the study and randomized into two groups. Postoperatively, group A received 0.125% epidural levobupivacaine and group B received saline. Both groups also received intravenous piritramide as a rescue analgesic. Pain intensity, rescue analgesic consumption, blood glucose, cholesterol and cortisol levels, postoperative blood loss, paresthesia, time to first postoperative defecation, and length of hospital stay were recorded. Sixty-eight patients completed the study. The visual analog scale score (mean 2 vs. 4, p = 0.01), consumption ofpiritramide (25 mg vs. 51.5 mg, p = 0.01) and metamizole (1400 vs. 1875 mg, p < 0.01), incidence of nausea (6% vs. 28% p = 0.02) and blood loss (450 mL vs. 650 mL, p < 0.05) were significantly lower in group A. Bowel recovery and first postoperative defecation also occurred earlier in group A (6% vs. 45%, p < 0.01). Blood cortisol, glucose and cholesterol levels and the incidence of paresthesia did not differ between the groups. In conclusion, after spinal fusion, postoperative epidural administration of levobupivacaine provides better analgesia and fewer side effects with no impact on stress response.
authors.forename: Darja
authors.initials: D
authors.lastname: Servicl-Kuchler
authors.forename: Branka
authors.initials: B
authors.lastname: Maldini
authors.forename: Alain
authors.initials: A
authors.lastname: Borgeat
authors.forename: Nada
authors.initials: N
authors.lastname: Bilić
authors.forename: Robert
authors.initials: R
authors.lastname: Kosak
authors.forename: Blaz
authors.initials: B
authors.lastname: Mavcic
authors.forename: Vesna
authors.initials: V
authors.lastname: Novak-Jankovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D003672:Defecation; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D010892:Pirinitramide / Q000008:administration & dosage; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000517:prevention & control; D020127:Recovery of Function; D013123:Spinal Fusion / Q000009:adverse effects*; D013312:Stress, Physiological
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010892:Pirinitramide; D000077554:Levobupivacaine; D002045:Bupivacaine