Intrathecal fentanyl in spinal anesthesia for appendectomy.

OBJECTIVE: The authors assessed the effectiveness of the administration of fentanyl in spinal anesthesia for appendectomy. MATERIAL AND METHOD: Forty patients randomized double-blind, were recruited to receive either 4 ml of 0.5% hyperbaric bupivacaine + 20 mg of fentanyl (Group F) or 4 ml of 0.5% hyperbaric bupivacaine 0.5% + 0.4 ml normal saline (Group S). RESULTS: There were no significant differences in the highest analgesic level between the groups. The number of segments regressed at 60 min in Group F was statistically less than in Group S (0 vs. 2; P 0.002). Group F showed significantly lower median VNS pain scores than Group S (0 vs. 3; P 0.004). Time to first required postoperative analgesics in Group F was significantly higher than in Group S (13.6 vs. 6.3 h, P < 0.001). The incidence of shivering in Group F was significantly lower than Group S (35% vs. 70%; P 0.023). There were no significant differences in the incidence of nausea, vomiting, hypotension and urinary retention. No patient developed respiratory depression or PDPH. The patients' satisfaction of spinal anesthesia was 100% in Group F and 80% in Group S. CONCLUSION: Intrathecal 20 microg fentanyl significantly improved the quality of analgesia, it prolonged the duration of bupivacaine in spinal anesthesia and delayed the analgesics requirement in the early postoperative period. Shivering was less frequently found in the fentanyl group.

Spinal morphine for post-operative analgesia after lumbar laminectomy with fusion.

BACKGROUND: Intrathecal administration of preservative free morphine (spinal morphine) provides excellent post-operative analgesia. Since the dura is readily accessible by the surgeon during lumbar spinal surgery, it would be convenient and attractive to administer morphine into the spinal space to provide adequate post-operative analgesia in these patients. METHOD: A prospective randomized controlled study evaluated the post-operative analgesic effect of spinal morphine after lumbar laminectomy with fusion. Forty patients were randomly allocated to two groups, morphine (MO) or normal saline (NSS). Morphine 0.3 mg in normal saline 0.3 ml or normal saline 0.3 ml was injected into the dural sac under direct visualization before closing the wound. An intravenous PCA morphine device was provided for post-operative pain relief. RESULTS: Median visual analog scale (VAS) pain scores were lower in the MO group at 2, 4, 24 and 48 h after surgery (1, 1, 2.75 and 1.5 cm in the MO group vs 4.25, 4.25, 5 and 4 cm in the NSS group) (p < 0.05). The time to first patient control analgesia (PCA) demand was delayed in the MO group (131.7 min vs 29.6 min) (p < 0.05). The cumulative doses of PCA morphine consumption were lower in the MO group in the first 24 h and 24-48 h (13.7 and 15.9 mg vs 41.3 mg and 27.1 mg) (p < 0.001). The incidence of pruritus was higher in the MO group in 24 h and 24-48 h (45%, and 45% vs 5% and 10%) (p < 0.05). The incidence and severity of nausea, vomiting and sedation were not different. No patient developed respiratory depression or postdural puncture headache (PDPH). The patients' satisfaction with post-operative pain management was 100 per cent in the MO group and 85 per cent in the NSS group. CONCLUSION: Spinal morphine improved post-operative pain relief after lumbar laminectomy.