L. Niemi et al., TECHNICAL PROBLEMS AND SIDE-EFFECTS ASSOCIATED WITH CONTINUOUS INTRATHECAL OR EPIDURAL POSTOPERATIVE ANALGESIA IN PATIENTS UNDERGOING HIP-ARTHROPLASTY, European journal of anaesthesiology, 11(6), 1994, pp. 469-474
Fifty-five patients undergoing hip arthroplasty under spinal anaesthes
ia (4 ml of 0.5% plain bupivacaine) were randomized to receive post-op
erative analgesia either using an intrathecal or an epidural catheter.
Associated technical problems and side effects were studied. In both
groups per-operative analgesia was achieved with intrathecal 0.5% plai
n bupivacaine, 4 ml. In the intrathecal infusion group a bolus dose of
100 mug morphine was injected through a spinal 28 gauge catheter foll
owed by a 24 h infusion of 200 mug morphine (8.3 mug h-1). In the epid
ural infusion group a bolus dose of 2 mg of morphine was injected befo
re the epidural 24 h infusion was started (morphine 200 mug h-1 + 0.25
% bupivacaine 4 ml h-1). There were 10 catheter failures (two could no
t be inserted) in the intrathecal group and one in the epidural group.
Three epidural catheter infusions failed due to other technical probl
ems. The number of side effects was 21 in the remaining spinal group (
n = 20) and 18 in the 20 epidural group patients with successful infus
ions. One patient in the spinal catheter group developed post-dural pu
ncture headache. For post-operative pain relief the patients in the ep
idural group needed less supplementary intramuscular oxycodone (five d
oses/four patients) than the spinal group (17 doses/nine patients) (P<
0.05).