Dr. Shiva Prasad M.S, Dr. Ravi Kumar.T.V, Dr. Rangaswamy B.T, Dr. Vinay Jain K, Dr. Annapurna Ravikumar
Abstract: Purpose Comparison of Epidural irrigation with Bupivacaine, Triamcinolone and Buprenorphine in one group with Triamcinolone and Buprenorphine in one group for postoperative analgesia in patients undergoing Lumbar Discectomy Surgery. Methods A prospective single blind randomised controlled study for 60 ASA I and II adult patients scheduled for elective herniated lumbar discectomy under general anesthesia. All patients involved in the study were diagnosed to have Intervertebral lumbar disc prolapse with neural compression. Pain scores with the visual analogue scale, time required for demand of first parenteral analgesic and side effects were assessed during the postoperative period. The epidural space was applied topically over the nerve root prior to closure with 1 ml of 0.25 % Bupivacaine, 40 mg Triamcinolone, 300mcg Buprenorphine (3 drug cocktail) in group I (n = 30) and 40 mg of Triamcinolone & 300 mcg of Buprenorphine (2 drug cocktail) in group II (n = 30). A blinded investigator assessed the post-operative pain using a 0-10 point Visual Analogue Scale (0-no pain, 10-unbearable pain). Significant pain was indicated by VAS > 5 and used as a cut off point for rescue analgesia with Tramadol 50 mg IV. Both the groups were compared for rescue analgesia - time from wound infiltration to time of administration of first dose of Tramadol and total consumption of Tramadol in 24hrs. Results Mean VAS scores were similar in both group I as compared to group II. Patients treated with infiltration of Epidural space with Triamcinolone and Buprenorphine had similar effect to epidural infiltration with Bupivacaine, Triamcinolone and Buprenorphine in control of pain at 24 hours post-surgery. However the pain control immediately post surgery upto 12 hrs was much significant in patients who received cocktail of 3 drugs. Patient requiring rescue analgesia was significantly higher in those who received 2 drug cocktail. Conclusion Epidural Irrigation with Buprenorphine-Triamcinolone and Bupivacaine-Triamcinolone-Buprenorphine provided similar pain relief at 24hrs post-surgery. Pain control immediately post surgery upto 12 hrs was much significant in patients who received cocktail of 3 drugs. Both of the combination of which can effectively control the post-operative pain in patients undergoing lumbar discectomy and minimise the use of IV opioids and thus their systemic side effects.
Keywords: Epidural Irrigation, Cocktail, Buprenorphine, Triamcinolone, Bupivacaine, Lumbar Discectomy