RELIEF OF POST SURGICAL PAIN BY PATIENT CONTROLLED EPIDURAL ANALGESIA (PCEA) WITH BUPRENORPHINE AFTER COMBINED SPINAL-EPIDURAL ANESTHESIA

Abstract

S227 Combined spinal-epidural anesthesia (CSEA) offers the advantage of rapid and profound anesthesia with the capability of providing epidural analgesia for the management of post surgical pain. The present study evaluated the safety and efficacy of patient controlled epidural analgesia (PCEA) with buprenorphine following CSEA. METHOD: Eighty adult patients of ASA class I-II who were scheduled for lower abdominal and lower extremity surgeries were divided into 2 equal groups: Group A received CESA with 17G epidural needle inserted at L3-4 interspace through which 25G Whittaker needle was introduced into the subarachnoid space and hyperbaric bupivacaine 0.2mg/kg was injected. After injection the Whittaker needles were removed and epidural catheter was placed. Group B received epidural anesthesia with 2% lidocaine via indwelling catheter inserted at L3-4. After surgery when the patient first complained of pain PCEA was given by Graseby-9300 pump with loading dose 5 ml, continuous infusion 0.5ml/hr and PCA dose 1 ml (lock out interval 20 min.) of buprenorphine 0.0015% in bupivacaine 0.15%. Vital signs, pain intensity by VAS, frequency and dose of PCEA, and adverse effects were recorded for 24 hr. postoperatively. RESULT: The demographic data were comparable between the 2 groups. The analgesic effect, dose of epidural drugs used and the adverse effect profile were very similar for the 2 groups without significant difference (Table 1 and Table 2). The incidence of adverse effects were noticeably low.Table 1: PCEA dose and Pain scoreTable 2: Adverse EffectsDISCUSSION: Our study showed that PCEA with buprenorphine can be used safely to provide effective relief of post surgical pain after CSEA.