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

Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

“…The 23 RCTs that tested therapies administered in the preoperative period included systemic pharmacological therapies (14 studies), locoregional therapies (7 studies), and electrical stimulation (2 studies) (see Table ).…”

“…Of the 7 RCTs that studied drugs locoregionally administered to prevent and treat postoperative pain after lumbar spine procedures, 4 studies tested the combination of bupivacaine with other drugs, while 2 compared the effectiveness between epidural and general anesthesia, and 1 evaluated the efficacy of ropivacaine . Of the 4 RCTs that tested bupivacaine, 1 demonstrated that bupivacaine can effectively reduce postoperative pain similarly to levobupivacaine, 1 showed that bupivacaine is more effective when combined with fentanyl and intrathecal magnesium sulphate (MgSO 4 ), 1 proved that it is less effective than dexmedetomidine in reducing pain, and 1 proved supremacy in postoperative pain prevention when administered as a spinal injection instead of epidurally or as a combined administration . The 2 RCTs that compared epidural and general anesthesia found that epidural anesthesia is the best alternative in terms of pain management, surgeons’ and patients’ satisfaction, and costs .…”

Lumbar laminectomy with segmental continuous epidural anesthesia

“…Düger et al . [7] compared spinal, continuous epidural and combined spinal epidural anesthesia with the addition of morphine for lumbar laminectomy in terms of anesthesia, intra- and post-operative analgesia and side-effects and found that all three groups were similar in surgery time, peak sensory levels, heart rate, mean arterial pressure, peripheral SpO 2 and intra-operative Ramsey sedation score. Post-operative pain score were higher in spinal anesthesia group along with a higher incidence of nausea and vomiting attributed to more morphine consumption for post-operative pain.…”

How much medicine do spine surgeons need to know to better select and care for patients?

“…[123031] Jellish and Shea observed multiple advantages of spinal anesthesia (e.g., combinations of subarachnoid and epidural dosing schemes) for lumbar spinal surgery. Intraoperatively, patients position themselves, mitigating neurological deficits associated with general anesthesia in the prone position, intraoperative blood loss (IBL) is reduced, and patients are more hemodynamically stable.…”

“…also documented the efficacy (postoperative analgesia/sedation) and reduced side effects associated with utilizing epidural, or combined spinal/epidural anesthesia vs. spinal anesthesia alone (all with systemic morphine) for performing 64 lumbar lamnectomies. [12]…”