Abstract
POSTOPERATIVE ANALGESIA FOR LUMBAR LAMINOPLASTY: SUBCUTANEOUS FENTANYL VS. EPIDURAL FENTANYL WITH ROPIVACAINE

*Tomoki Nishiyama

ABSTRACT

Spine surgery has severe postoperative pain. The present study compared postoperative analgesic effects of epidural infusion of bupivacaine with fentanyl and subcutaneous infusion of fentanyl in lumbar laminoplasty. Forty five patients for lumbar laminoplasty were divided into three groups; control, epidural and subcutaneous groups. Before the end of surgery, an epidural catheter was put into the center of the surgical region under direct vision by a surgeon in the epidural group. From the end of surgery, fentanyl 1000 μg + droperidol + 0.2% ropivacaine 76 mL (total 100 mL) was administered epidurally at 2 mL/h in the epidural group, fentanyl 1000 μg + droperidol + saline 26 mL (total 50 mL) was administered subcutaneously at 1 mL/h in the subcutaneous group. Nothing was administered in the control group. Postoperative pain was rated using a visual analogue scale (VAS) 0 to 10. Analgesic rescue was intramuscular pentazocine 15 mg. The frequency of pentazocine, VAS scores, hemodynamics, nausea/vomit and headache were compared among the groups. Frequency of pentazocine was significantly larger in the order of the Control, Subcutaneous, and Epidural groups. VAS scores were significantly lower in the order of the Epidural, Subcutaneous, and Control groups. Frequency of nausea, vomit, and headache were not different among the groups. In conclusion. for postoperative analgesia in lumbar laminoplasty, an epidural infusion of fentanyl, droperidol and 0.2% ropivacaine had better postoperative analgesia than subcutaneous infusion of fentanyl and droperidol without increasing side effects.

Keywords: Spine surgery, Postoperative analgesia, Epidural, Subcutaneous, Fentanyl, Ropivacaine.


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