Continuous spinal anaesthesia or continuous epidural anaesthesia for post-operative pain control after hip replacement ?

Both continuous spinal anaesthesia and continuous epidural anaesthesia are supposed to provide adequate post-operative pain relief. The purpose of thi s randomized, prospective study was to compare the quality of analgesia, oc curence of side effects and patient satisfaction between spinal and epidura l administration of bupivacaine during the first post-operative 72 h. One h undred and two patients scheduled for hip arthroplasty were randomly assign ed to one of two groups: Group 1 received continuous spinal anaesthesia for intra-operative and post-operative management, Group 2 received continuous epidural anaesthesia. Immediately after surgery, the continuous spinal ana esthesia-group received a 1-mL bolus (bupivacaine 0.25%), followed by a con tinuous infusion of 10 mL over 24 h. The continuous epidural anaesthesia-gr oup received a 10-mL bolus (bupivacaine 0.25%), followed by 2 mL h(-1). The level of pain was gauged from a verbal rating score and from a visual anal ogue scale; the degree of motor blockade was recorded using the Bromage sco re. In the continuous spinal anaesthesia-group 90.2% reported complete anal gesia on the verbal rating scale, but only 21.6% of the continous epidural anaesthesia-group did. The visual analogue scale scores given by the contin uous spinal anaesthesia-group were significantly lower than those of the co ntinuous epidural anaesthesia-group. The percentage of patients with a moto r block was significantly higher in the continuous spinal anaesthesia-group on the day of surgery and at the first post-operative day. During the firs t 24 h, nausea and vomiting occured more often in the continuous epidural a naesthesia-group. The satisfaction was considered excellent in 92.2% of the continuous spinal anaesthesia-group and in 70.6% of the continuous epidura l anaesthesia-group. It is concluded that continuous spinal anaesthesia and continuous epidural anaesthesia are effective and safe for post-operative pain relief after hip replacement. Compared with continuous epidural anaest hesia, continuous spinal anaesthesia provides faster onset of pain relief, ensures better analgesia and results in more satisfied patients.