Effects of Combined Lower Thoracic Epidural/General Anesthesia on Pain Control in Patients Undergoing Elective Lumbar Spine Surgery

Study Design. Randomized controlled trial. Objective. Our objective was to compare postoperative pain relief and operating field condition of single-shot, low-thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone. Summary of Background Data. Prior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field. Methods. A total of 22 patients scheduled for elective lumbar spine surgery were enrolled and randomly allocated into two groups. Group B (block) received a single-shot epidural block with 0.25% bupivacaine plus 4mg of morphine with a total volume of 10 mL before receiving general anesthesia with desflurane, and cisatracurium. Group G (general) received general anesthesia alone with desflurane, cisatracurium, and any systemic analgesia deemed appropriate by the attending anesthesiologist. Postoperative pain score, opioid consumption, intraoperative blood loss, surgical field rating score, and other side effects were recorded at the postanesthesia care unit (PACU) and at 24 hours postoperatively. Results. Both groups were comparable for age, sex, body mass index, and American Society of Anaesthesiologists physical status. Fentanyl consumption was significantly lower (P<0.05) for group B (block) at the PACU and 24 hours. Mean fentanyl consumption at PACU was 20 mu g for group B and 85 mu g for group G. At 24 hours mean fentanyl consumption was 80 mu g for group B and 386 mu g for group G. Pain measured with numerical rating scale, surgical field rating score, blood loss, and complications were similar in both groups. Conclusion. Single-shot low-thoracic epidural anesthesia combined with general anesthesia provides better pain control than general anesthesia alone.