Effects of Continuous Intravenous Analgesia Versus Epidural Analgesia after Lumbar Spinal Surgery: A Prospective Study.

Oh, Kyu Sung; Shin, Moon Soo; Gil, Hyun Joo; Hur, Ryoong; Choi, Hun Kyu; Ahn, Jung Yong; Kwon, Seong Oh

Original Article

Journal of Korean Neurosurgical Society 2001;30(12): 1394-1398.

Kyu Sung Oh, Moon Soo Shin, Hyun Joo Gil, Ryoong Hur, Hun Kyu Choi, Jung Yong Ahn, Seong Oh Kwon

¹Department of Neurosurgery, Pundang CHA Hospital, Pochon CHA University College of Medicine, Sungnam, Korea.
²Department of Anesthesiology, Pundang CHA Hospital, Pochon CHA University College of Medicine, Sungnam, Korea.
³Department of Neurosurgery, Gumi CHA Hospital, Pochon CHA University College of Medicine, Gumi, Korea.

ABSTRACT

OBJECTIVE
The purpose of this non-randomized prospective study was to evaluate the safety and efficacy of continuous intravenous nalbuphine-ketorolac-droperidol(CIA) versus continuous infusion of epidural morphine-bupivacaine(CEA) for pain control after lumbar spinal surgery.
METHODS
Twenty-one patients who underwent spine surgery including laminectomy, fusion with fixation were assigned to receive an intravenous bolus of nalbuphine 5mg and ketorolac 15mg, followed by a continuous infusion of nalbuphine 25mg, ketorolac 105mg, and droperidol 5mg mixed with normal saline 98cc(2cc/hr). Twenty patients received a bolus infusion of morphine 2mg and 0.125% bupivacaine 8cc followed by a continuous intravenous infusion of 100cc 0.125% bupivacaine and morphine sulfate 8.0mg(2cc/hr). Pain score was measured on a visual analogue scale(VAS). It's safety and efficacies were compared with the results of continuous infusion of epidural morphine-bupivacaine, which was reported previously by same authors. A continuous infuser was used to give epidural morphine-bupivacaine and intravenous nalbuphine-ketorolac-droperidol.
RESULTS
In general, mild pain, pain less than 3 VAS scores, was observed postoperatively from 30minutes to 72hours in CEA group, and from 6 hours to 72 hours in CIA group. The early postoperative pain was controlled easily in 6 hours in CEA group, compared to CIA group(p<0.05). However, there was no statistical significance in 72 hours on pain scores between CEA and CIA groups after 6-12hours of pain managements. Pruritus, nausea and vomiting, and urinary retention were more frequent in CEA group.
CONCLUSION
CIA and CEA are considered effective methods in postoperative pain managements. However, adequate doses in early intravenous infusion and continuous intravenous analgesia with nalbuphine-ketorolac-droperidol will be needed for better control in early postoperative pain with less side effects.

Key Words: Epidural anesthesia; Intravenous anesthesia; Nalbuphine; Ketorolac; Droperidol; Lumbar spinal surgery