Better pain control with epidural for spine surgery

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HealthDay News -- For reconstructive spine surgery, combined epidural and general anesthesia results in better pain control and other outcomes compared with general anesthesia plus narcotics, researchers found.

Patients who underwent epidural anesthesia experienced significantly less pain and nausea, earlier mobility, higher satisfaction and significantly less introperative and postoperative blood loss than those who underwent general anesthesia with opioids, Anna A. Ezhevskaya, MD, from the Nizhny Novgorod Research Institute of Traumatology and Orthopedics in Russia, and colleagues reported in Spine.

They randomly assigned 85 patients undergoing reconstructive spine surgery to two pain management groups:

  • Epidural anesthesia and endotracheal anesthesia with sevoflurane during surgery, followed by continuous epidural analgesia with ropivacaine, fentanyl and epinephrine after surgery (n=45)
  • General anesthesia with sevoflurane and fentanyl and systemically administered opioids after surgery (n=40)

In addition to previously described benefits, the epidural group also had lower levels of glucose, cortisol and interleukins-1β, -6 and -10 postoperatively.

"Combined epidural/general anesthesia and postoperative epidural analgesia produced better pain control, less bleeding and a lower surgical stress response than general anesthesia with postoperative systemically administered narcotic analgesia," the researchers wrote. "This technique deserves further study in the setting of major spinal surgery."


References

  1. Ezhevskaya AA et al. Spine. 2013; 38(15):1324-1330.
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