• Marvin Thepsoparn, Jariya Sereeyotin, and Patt Pannangpetch.
• Pain Management Research Unit, Department of Anesthesiology, Faculty of Medicine, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Bangkok, Thailand.
• Spine. 2018 Oct 15; 43 (20): 1381-1385.

Study DesignRandomized controlled trial.ObjectiveOur objective was to compare postoperative pain relief and operating field condition of single-shot, low-thoracic epidural anesthesia combined with general anesthesia versus general anesthesia alone.Summary Of Background DataPrior studies have suggested that continuous epidural analgesia provides better postoperative pain relief and less intraoperative blood loss, but with the risk of the epidural catheter contaminating the surgical field.MethodsA total of 22 patients scheduled for elective lumbar spine surgery were enrolled and randomly allocated into two groups. Group B (block) received a single-shot epidural block with 0.25% bupivacaine plus 4 mg of morphine with a total volume of 10 mL before receiving general anesthesia with desflurane, and cisatracurium. Group G (general) received general anesthesia alone with desflurane, cisatracurium, and any systemic analgesia deemed appropriate by the attending anesthesiologist. Postoperative pain score, opioid consumption, intraoperative blood loss, surgical field rating score, and other side effects were recorded at the postanesthesia care unit (PACU) and at 24 hours postoperatively.ResultsBoth groups were comparable for age, sex, body mass index, and American Society of Anaesthesiologists physical status. Fentanyl consumption was significantly lower (P < 0.05) for group B (block) at the PACU and 24 hours. Mean fentanyl consumption at PACU was 20 μg for group B and 85 μg for group G. At 24 hours mean fentanyl consumption was 80 μg for group B and 386 μg for group G. Pain measured with numerical rating scale, surgical field rating score, blood loss, and complications were similar in both groups.ConclusionSingle-shot low-thoracic epidural anesthesia combined with general anesthesia provides better pain control than general anesthesia alone.Level Of Evidence2.

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