A COMPARISON BETWEEN MULTIMODAL ANALGESIA AND SINGLE MODE ANALGESIA IN LUMBAR VERTEBRAL SURGERY
Kirolos Emad Moris Misak;
Abstract
In our study, 102 patients scheduled to undergo single or double level lumbar discectomy or fixation surgery under general anesthesia were randomly assigned to one of two groups:
Group A:The multimodal group who received acetaminophen 1 gm, ketamine 0.25 mg/kg, morphine 3 mg, all given I.V before induction of general anesthesia. Then intraoperative analgesia was maintained by local infiltration of the surgical site by mixture of bupivacaine and lidocaine and I.V infusion of ketamine and morphine in a rate of 5 and 1 mg/hour respectively.
Group B: the morphine group received morphine in a dose of 0.1 mg/kg before induction of general anesthesia. Then intraoperative analgesia was maintained by morphine increments of maximum 3 mg.
The study continued for 6 hours postoperative and demonstrated that using multimodal analgesia produce more favorable pain relief and maintain stable hemodynamics in the intraoperative and early postoperative periods with less stress response, narcotic consumption and narcotic induced respiratory depression.
Regarding systolic and diastolic blood pressures and heart rate, there was a significant decrease in intraoperative and early postoperative values in the multimodal group than morphine group.
Regarding narcotic consumption there was significant lower consumption in the multimodal group and also significant longer interval time for requesting analgesia.
Regarding respiratory depression, there was no respiratory depression in both groups, but higher PaO2, and lower PaCO2 were noticed in the multimodal group.
Regarding stress response to surgery, it was much lower in the multimodal group, however intraoperative cortisol levels between the two groups were not statistically significant.
We concluded that the use of multimodal analgesia prolonged the duration of postoperative analgesia and decrease the intensity of pain, with stable hemodynamics and without any respiratory burden, furthermore it decreases the consumption of narcotics by decreasing the frequent requesting of analgesia. Moreover, cortisol levels didn’t decrease significantly with the use of multimodal analgesia.
Group A:The multimodal group who received acetaminophen 1 gm, ketamine 0.25 mg/kg, morphine 3 mg, all given I.V before induction of general anesthesia. Then intraoperative analgesia was maintained by local infiltration of the surgical site by mixture of bupivacaine and lidocaine and I.V infusion of ketamine and morphine in a rate of 5 and 1 mg/hour respectively.
Group B: the morphine group received morphine in a dose of 0.1 mg/kg before induction of general anesthesia. Then intraoperative analgesia was maintained by morphine increments of maximum 3 mg.
The study continued for 6 hours postoperative and demonstrated that using multimodal analgesia produce more favorable pain relief and maintain stable hemodynamics in the intraoperative and early postoperative periods with less stress response, narcotic consumption and narcotic induced respiratory depression.
Regarding systolic and diastolic blood pressures and heart rate, there was a significant decrease in intraoperative and early postoperative values in the multimodal group than morphine group.
Regarding narcotic consumption there was significant lower consumption in the multimodal group and also significant longer interval time for requesting analgesia.
Regarding respiratory depression, there was no respiratory depression in both groups, but higher PaO2, and lower PaCO2 were noticed in the multimodal group.
Regarding stress response to surgery, it was much lower in the multimodal group, however intraoperative cortisol levels between the two groups were not statistically significant.
We concluded that the use of multimodal analgesia prolonged the duration of postoperative analgesia and decrease the intensity of pain, with stable hemodynamics and without any respiratory burden, furthermore it decreases the consumption of narcotics by decreasing the frequent requesting of analgesia. Moreover, cortisol levels didn’t decrease significantly with the use of multimodal analgesia.
Other data
| Title | A COMPARISON BETWEEN MULTIMODAL ANALGESIA AND SINGLE MODE ANALGESIA IN LUMBAR VERTEBRAL SURGERY | Other Titles | مقارنة بين التسكين المتعدد الوسائط والتسكين الأحادى الوضع في جراحة العمود الفقري القطني | Authors | Kirolos Emad Moris Misak | Issue Date | 2015 |
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