Comparative Study Between Combined Spinal Epidural Analgesia (CSEA) and Pre-Emptive Multimodal Analgesia for Pain Control in Joint Replacement Surgeries of Lower Limbs

Abstract

Background and aims: Epidural analgesia has been considerably used for postoperative analgesia in Orthopaedic surgeries, however, combination of opioid and non-opioid medications in the perioperative period seems to provide an effective alternative. Objectives: To compare the efficacy of pre-emptive multimodal analgesia with combined spinal epidural for postoperative analgesia in lower limb arthroplasties. Materials and methods: 50 patients scheduled for elective lower limb Arthroplasties were randomly divided into two groups. Spinal anaesthesia with 2.5ml of 0.5% Bupivacaine (heavy) plus 0.5ml (25µg) Fentanyl was given in both the groups for procedure. Group I received Cap. Pregabalin 150mg and Inj Paracetamol 1000mg IV 1 hour before surgery and 75mg 12 hourly and 1000mg IV 8 hourly respectively, while Group II received epidural top up with 10 ml of 0.125% bupivacaine 8 hourly, both for 3 days postoperatively. Perioperative haemodynamics, postoperative VAS, rescue analgesics requirement, and Patient satisfaction level were monitored for 72 hours. Results: Postoperative VAS score was significantly higher in Group II from 4th hour postoperatively, and, accordingly, more patients in this group required rescue analgesia (21 and 20 in Group II vs 10 and 1 in group I in 12-24 hrs and 24-36 hrs respectively with p value <0.001). Modified Bromage score, haemodynamics and side effect profiles were comparable in the groups, however, patient satisfaction level was more in Group I (p value <0.001) after 72 hours. Conclusion: Pre-emptive multimodal analgesia can be used as an effective alternative to epidural for postoperative analgesia in patients undergoing lower limb joint replacement surgeries. Keywords: Pre-emptive multimodal analgesia, Combined spinal epidural analgesia, Lower limb arthroplasties, Postoperative analgesia