Perispinal morphine for relief after perianal surgery

ABSTRACT

Perispinal anesthesia allows injection of epidural [ED] or intrathecal [i.t] morphine to provide long-lasting postoperative analgesia. To compare these two routes, a prospective, randomized study of 40 patients undergoing perianal surgery was performed. Combined spinal-epidural anesthesia with 6 mg of i.t. hyperbaric bupivacaine plus sufentanil 5 micro g and additional ED lidocaine was used. Additionally, each patient received either 2mg [2 ml] of ED morphine plus 1 ml of i.t. normal saline [ED group, n =20] or 0.075 mg [1 ml] of i.t. morphine plus 2 ml of ED normal saline [i.t. group n = 20]. Parentral propacetamol was given for additional postoperative analgesia. No major respiratory depression occurred. Time for first demand of propacetamol was similar in the ED and i.t. groups [250 min]. During the first 24 postoperative hours, VAS pain scores were greater in the i.t. group [p =0.03]. The incidence of side effects such as sedation, pruritis, nausea and vomiting was equal in both groups. The ED protocol was more effective than the i.t. protocol, whilest side-effects were similar