Addition of Triamcinolone or Pethidine to Epidural Bupivacaine can not Improve Postoperative Pain Relief in Lumbar Discectomy

There is uncertainty as to whether addition of steroids or narcotics to epidural local anesthetics improves pain control in spine surgery. The aim of the current placebo-controlled, double blind study was to assess the postoperative pain score using a single epidural administration of bupivacaine alone, bupivacaine plus triamcinolone or bupivacaine plus pethidine after wound closure in patients underwent lumbar discectomy.
108 patients were included in this study. After closure of wound, patients were randomly assigned to receive bupivacaine 0.25% (group A), bupivacaine 0.25% plus triamcinolone 40 mg (group B), bupivacaine 0.25% plus pethidine 50 mg (group C) or saline (group D) via epidural catheter. 5 or 10ml of prepared medication was infiltrated in epidural space based on one or two segment procedures. Additional postoperative pain relief was provided using morphine. Patients were assessed with respect to pain score by visual analog scale (VAS), cumulative morphine requirement (mg), ambulation time (hour) and discharge time (day), at the postoperative period. Data were analyzed using chi-square, kruskal wallis, and ANOVA tests.
Mean pain scores were higher in group D at recovery time, 6 and 24 hours postoperatively (P<0.05). The mean total morphine consumption up to 48 hours after operation in groups A, B, C, and D were 1.4±1.5, 1.4±1.3, 1.4±1.3 and 4.6±2.1 mg, respectively (P<0.05). The ambulation time and discharge time were higher in group D (P<0.05). There were not any statistically differences between group A, B and C in order to above variables. In conclusion, epidural administrations of bupivacaine 0.25% results in lower pain scores, opioid consumption and ambulation time and also discharge time when compared with placebo. Triamcinolone or pethidine added to bupivacaine could not improve these parameters.