Efficacy of Sacral Epidural Blockade as Perioperative Analgesia for Lumbar Laminectomy Surgeries

Abstract

Patients undergoing lumbar laminectomy experience severe pain in the postoperative period, which may increase the incidence of postoperative morbidity and complications. Adequate pain relief hastens rehabilitation, and decreases the incidence of chronic pain. Adult caudal blockade has fallen from favor in the anesthesia community. The majority of anesthesia providers now use lumbar epidurals and spinals for surgeries that can be done with caudals. Many claim the procedure is difficult to perform and the outcome of the block is unpredictable. Stress responses associated with surgical trauma may cause subtle changes in some vital and hormonal parameters. increased plasma cortisol level and suppressed anabolic hormones, such as insulin, may have deleterious effects during the perioperative period. Caudal bupivacaine and morphine administration has been used for postoperative pain relief in lower abdominal surgery, thoracotomy, and liver transplantation. In this study, while general anesthesia is administered to all patients undergoing lumbar laminectomy surgeries, we evaluated and compared the efficacy of caudal image guided epidural- bupivacaine or morphine administration at low concentrations that doesn’t cause any motor block on the attenuation of the stress response during (intra) and after (post) lumbar laminectomy surgeries. Our results revealed that patients in the caudal bupivacaine group (A) and caudal morphine group (B) showed significantly lower intraoperative stress response to surgery, postoperative pain scores, no postoperative motor block with the concentration 0.125% of bupivacaine used, lesser doses of postoperative rescue analgesics were needed in comparison with patients in the the control group (C) for 24hrs, while the caudal morphine group (B) showed significantly lower incidence of adverse effects like delayed ambulation and urinary retention in comparison to the caudal bupivacaine group (A). Preemptive analgesia with a single caudal epidural injection of morphine is a safe, simple and effective technique giving postoperative pain relief for a period of up to 24 hours. Prone positions adopted for posterior surgeries on the lumbosacral spine and the ready availability of image intensifiers during such surgeries make this technique a very convenient and suitable one for such surgeries.