Comparative Study of the Effect of Continuous Caudal Epidural With General Anesthesia Versus General Anesthesia on Intraoperative and Postoperative Analgesic Requirements for Lumbar Fixation.

STUDY

DESIGN

The study was an interventional, randomized, prospective comparative clinical trial on 60 patients scheduled for lumbar fixation surgery.

STUDY AIM: The study goal was to justify the effectiveness of combined continuous caudal epidural with general anesthesia compared to general anesthesia alone as analgesia for lumbar fixation patients.

OVERVIEW OF LITERATURE: Pain control during the intraoperative and postoperative period for spine surgeries is crucial. Much literature had proved that caudal analgesia is an acceptable alternative approach for intraoperative and postoperative analgesia.

Methods

60 patients were equally allocated to two groups: Group A (Study group) and Group B (Control group). For Group A patients', general anesthesia induction was followed by fluoroscopic-guided caudal epidural catheter insertion. Thirty patients of Group B received general anesthesia only. Various parameters were assessed, including postoperative pain and hemodynamic parameters, time to rescue analgesia, estimated blood loss, surgeon satisfaction with the surgical field, total intraoperative and postoperative narcotics, and common postoperative complications of caudal epidural.

RESULTS

The intraoperative heart rate and mean blood pressure showed significant differences. Group A showed a significantly lower intraoperative fentanyl dose. Group A patients had nonsignificant lower blood loss and higher surgeon satisfaction with the surgical field. Postoperative numeric pain scale was significantly lower in the study group. Study group had significant less frequent postoperative morphine need and significant lower total 6-h morphine dose. The rate of requesting the morphine first rescue dose was significantly later and lower in the study group. There was a significant less frequent sedation, in addition to a significant less frequent nausea and vomiting in the study group.

CONCLUSIONS

Combined continuous caudal epidural with general anesthesia had lower intraoperative fentanyl dose and postoperative morphine dose, with overall lower opioid requirements and better pain control. Trial Registration: Clinical trial.gov.identifier; NCT06929611.