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POSTOPERATIVE CONTINUOUS EPIDURAL ANALGESIA FOR SPINAL SURGERY PART I. EFFECTIVENESS AND SAFETY OF POSTOPERATIVE CONTINUOUS EPIDURAL ANALGESIA IN COMPARISON WITH THE TRADITIONAL METHODS OF POSTOPERATIVE ANALGESIA FOR SPINAL SURGERY


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Abstract

Material and methods. A prospective randomized study included 158 patients who were operated due to spinal pathology. Analgesic efficacy of traditional postoperative analgesia based on NSAIDs and other non-narcotic analgesics on demand was compared with continuous postoperative epidural analgesia. All patients before and after surgery were assessed with a screening questionnaire of pain intensity, quality of life and psycho-emotional status (VAS, HADS, DN4, LANSS and Pain Detect). Systemic hemodynamic parameters were also assessed. All patients were divided into three comparable groups. In 1 group (n - 60) traditional NSAID and other non-narcotic analgesics on demand were used. 2 group (n - 40) included patients who received continuous epidural analgesia of 0,2% ropivacaine at a rate of 2-6 ml/h during 3 days after surgery. In this group the epidural catheter was placed before surgery at 1-2 segments above the top edge of the incision line. In 3 group we used the continuous epidural analgesia (PEA) by 0,2% ropivacaine and disposable elastomeric pump DosiFuser (Spain), Tuoren (China), programmable ambulatory pumps Rithmic Evolution Micrel (Greece) at a rate of 2-6 ml/hour during 3 days after surgery. In this group, the epidural catheter was installed by surgeon during suturing into the top corner of the wound via separate puncture. Reserve analgesic in all groups was Lornoxicam 8 mg (Xefocam, Nikomed, Austria). Results. Results of the study showed that postoperative continuous epidural analgesia after spinal surgery is safe and highly effective technique. It provides a complete pain relief with minimal pharmacological load. The postoperative continuous epidural analgesia using disposable elastomeric pumps is easy to use and well tolerated. It creates an opportunity for verticalization of patients as early as possible and improve their ability for self-service.


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