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. 2018 Apr-Jun;34(2):237-241.
doi: 10.4103/joacp.JOACP_72_17.

Pre-emptive caudal epidural analgesia with ropivacaine for lumbosacral spine surgery: A randomized case control study

Navneh Samagh  1 , Raghavendra K Pai  2 , Thomas K Mathews  2 , Kiran Jangra  3 , Ravi G Varma  2
Affiliations

Pre-emptive caudal epidural analgesia with ropivacaine for lumbosacral spine surgery: A randomized case control study

Navneh Samagh et al. J Anaesthesiol Clin Pharmacol. 2018 Apr-Jun.

Abstract

Background and aims: Pre-emptive analgesia using caudal epidural technique is an underutilized technique in lumbosacral spine surgery patients. We intend to study if pre-emptive analgesia with a single caudal epidural injection of ropivacaine is an effective method of postoperative analgesia by assessing the quality and duration of pain relief and intraoperative opioid requirement.

Material and methods: Eighty patients undergoing lumbosacral spine surgeries by the posterior approach were randomized to ropivacaine (R) group (n = 40) and saline (S) group (n = 40). Patients in R group received caudal epidural injection of 20 ml of 0.2% ropivacaine for surgeries at or below L5 lumbar spine and 25 ml of 0.2% ropivacaine for surgeries between L2 and L5 lumbar spine. Patients in S group received similar amounts of normal saline. Patients were monitored in the immediate postoperative period and at 4, 8, 12, and 24 hours for pain using visual analogue scale (VAS) scale. Time to rescue analgesia and intraoperative fentanyl requirement were noted.

Results: The demographics, duration of anesthesia, and hemodynamic variables were comparable in both groups. The mean intraoperative fentanyl requirement (P = 0.001) and mean VAS scores were significantly lower in the R group in the immediate postoperative period, (P < 0.001), 4 hours (P < 0.001), 8 hours (P = 0.009), 12 hours (P = 0.007), and 24 hours (P = 0.046) postoperatively. The mean time to rescue analgesia was significantly longer in the R group (P < 0.001) compared to S group. No hemodynamic or neurological side-effects were observed in the groups.

Conclusion: Pre-emptive analgesia with caudal epidural injection of ropivacaine is a safe and effective method of postoperative analgesia.

Keywords: Analgesia; anesthesia; caudal; epidural; ropivacaine; spine; surgery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Comparison of mean heart rate at different time points between ropivacaine and saline groups
Figure 2
Figure 2
Comparison of mean systolic blood pressure at different time points between ropivacaine and saline groups
Figure 3
Figure 3
Comparison of mean diastolic blood pressure at different time points between ropivacaine and saline groups
Figure 4
Figure 4
Comparison of mean visual analogue scale at different time points between ropivacaine and saline groups
See this image and copyright information in PMC

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