The Effects of Intrathecal Bupivacaine (Marcaine) plus Morphine or Neostigmine or Fentanyl on Postoperative Pain, Nausea and Vomiting after Lumber Discectomy: A Randomized, Double Blind Clinical Trial

Abstract

Background: Pain management after lumbar discectomy is controversial. Although several pharmaceutical agents have been used for management of postoperative pain (POP), nausea and vomiting (PONV) after lumbar discectomy undergoing spinal anesthesia; however this issue remains elusive. The aim of the present study was to investigate the effects of intrathecal administration of bupivacaine (Marcaine) in addition to morphine, neostigmine or Fentanyl in management of POP and PONV after lumbar discectomy.

Materials and Methods: This was a randomized, double blind clinical trial being performed in Al-Zahra healthcare center affiliated with Isfahan University of Medical Sciences during a 1-year period from September 2012 to September 2013. We included those 116 patients with single lumbar disc herniation without neurological deficit undergoing discectomy. We excluded those with previous lumbar surgery and those in whom the dural sac was opened. Patients were randomly assigned to receive intrathecal administration of 15 mg bupivacaine in addition to 0.2 mg of morphine (n=47) or 50-150 µg of neostigmine (n=33) or 25 µg of fentanyl (n=36). The pain scores according to numeral pain scale (NPS) and well as incidence of PONV were recorded and compared between groups.

Results: The baseline characteristics were comparable between groups. The pain intensity after the operation was comparable between groups after 2 (p=0.187) and 4 (p=0.682) hours. However those who received bupivacaine and Fentanyl had significantly lower NPS scores after 6 (p=0.029), 12 (p=0.049) and 18 (p=0.013) hours. The incidence of PONV (p=0.269) and urinary retention (p=0.986) as well as amount of administered analgesics (p=0.128) was comparable between three study groups.

Conclusion: The results of the current study demonstrates that intrathecal administration of bupivacaine and fentanyl in those undergoing single lumbar discectomy via spinal anesthesia is associated with lower postoperative pain intensity.