POSTOPERATIVE ANALGESIA AFTER LUMBAR LAMINECTOMY - EPIDURAL FENTANYL INFUSION VERSUS PATIENT-CONTROLLED INTRAVENOUS MORPHINE

We compared the efficacy and safety of continuous epidural fentanyl in fusion with intravenous morphine via a patient-controlled analgesia sy stem ITV-PCA) in the management of postoperative pain after lumbar lam inectomy. Twenty patients undergoing elective lumbar laminectomy were randomly allocated to one of two groups. The epidural group (n = 10) r eceived an epidural fentanyl infusion (2 mu g/mL at 4-10 mL/h) while t he IV-PCA group (n = 10) received IV morphine through a PCA system. Th e general anesthetic technique was standardized. Visual analog pain sc ores were recorded at 12, 24 and and 48 h after the operation. The amo unt of morphine (or its equivalent in fentanyl) used over the 48-h pos toperative period was documented. The postoperative pain scores were s ignificantly lower in the epidural group than in the TV-PCA group thro ughout the study period. The total consumption of morphine (or its fen tanyl equivalent) over the 48-h period was significantly lower (P < 0. 001) in the epidural group compared to the IV-PCA group. Although more patients in the IV-PCA group required urinary catheterization and had somnolence than the epidural group, there was no difference in the in cidence of vomiting or pruritus. No patient developed respiratory depr ession or wound infection. We conclude that continuous epidural infusi on of fentanyl is superior to IV-PCA morphine in the management of pai n after lumbar laminectomy.