Anesthetic and analgesic effects in patients undergoing a lumbar laminectomy of spinal, epidural or a combined spinal-epidural block with the addition of morphine

Abstract

This study was designed to evaluate the anesthetic, analgesic and side effects of spinal, epidural and combined spinal-epidural anesthesia with the addition of morphine for lumbar laminectomy. A total of 66 patients undergoing lumbar laminectomy were included in the present study of whom 64 completed the study. Patients were randomly divided into three groups: (i) spinal anesthesia - the SA group; (ii) epidural anesthesia - the EA group; and (iii) combined spinal-epidural anesthesia - the CA group. Demographical data, surgical times and peak sensory levels of groups were similar. Heart rate, mean arterial pressure, and peripheral oxygen saturation did not differ between the three groups. No differences were observed intraoperatively in Ramsey sedation scale (RSS) scores between the groups, but postoperatively, although RSS scores were similar for the EA and CA groups, they were significantly lower for the SA group. The postoperative visual analogue scale pain scores were higher in the SA group compared to the EA and the CA groups except for the second postoperative hour. Time-to-use of the first patient controlled analgesia was similar for all groups. The total consumption of morphine over the 24-hour study period was significantly higher in the SA group compared to the EA and the CA groups. Postoperative nausea and vomiting frequencies were higher in SA group, but pruritus frequency was lower than the EA and the CA groups. In conclusion, although spinal, epidural, and combined spinal-epidural anesthesia are adequate and effective for lumbar laminectomies, epidural and combined spinal-epidural anesthesia techniques are more effective than spinal anesthesia for postoperative analgesia and sedation with lesser side effects. (C) 2011 Elsevier Ltd. All rights reserved.