Colloid versus crystalloid soaked gelfoam with morphine for postoperative pain relief after lumbar laminectomy

Abstract

Background: Epidural opiate analgesia carried by gelfoam in the epidural space is to improve the quality of perioperative pain relief. The aim of this study was to compare the analgesic efficacy of gelfoam soaked in morphine with crystalloids versus colloid versus direct application of morphine in epidural space in patients undergoing lumbar laminectomy under general anesthesia. Methods: This study was a prospective, randomized, double-blinded trial. 75 male and female patients aged from 18 to 65 years from ASA class I or II scheduled for Lumbar laminectomy surgery were randomly divided into three equal groups: group A: (control group): 5 ml of 1 mg/ml morphine was directly instilled over intact epidural space, group B (crystalloid group): apiece of gelfoam 5 cm  1 cm soaked in 5 mg morphine diluted with 5 ml crystalloid (0.9% sodium chloride) placed in intact epidural space; and group C (colloid group): apiece of gelfoam 5 cm  1 cm soaked in 5 mg morphine diluted with 5 ml hydroxyethyl starch 6% (HES 6%) placed in intact epidural space by the neurosurgeon. Total analgesics, time to first analgesic request, visual analogue scale (VAS), hemodynamics, respiratory rates and adverse effects were recorded. Results: As regards Patient's characteristics, age, gender, weight, ASA class and operative time were comparable in all studied groups, and groupsB and C showed less amount of analgesia, long time to analgesic request, and less main VAS. No statistically significant differences are in hemodynamics, and the incidences of side effects showed no statistically significant differences among the three groups of study. Conclusion: Epidural use of gelfoam soaked by morphine in HES 6% is an effective method for post operative analgesia after lumbar laminectomy.

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

“…Hassanein et al compared epidural gelfoam soaked in morphine 5 mg (diluted in crystalloid), epidural gelfoam soaked in morphine 5 mg (diluted in colloid) and epidural instillation with morphine 5 mg [35]. Rescue analgesia included IV diclofenac and intermittent IV morphine.…”

Effect of gelfoam soaked epidural dexmedetomidine or bupivacaine for postoperative analgesia in lumbar laminectomy: A prospective randomized clinical study

“…Various adjuvant such as morphine, buprenorphine, nalbuphine, ketamine, and steroids used alone in the form of gelfoam soaked to prolong the postoperative analgesia in spine surgery. [ 16 17 18 19 20 ] Easy access to epidural space during spine surgery has led to direct application of drug over the exposed dura mater. Free drug placed in epidural space at the time of the surgery is diluted by blood and tissue fluids, is lost into the disc space, and is absorbed systemically, thus limiting its duration of action,[ 21 ] but when soaked in gelfoam will remain for longer time and prolonging their duration of action.…”

“…[ 3 ] Patients with morphine directly instilled over intact epidural space (192 ± 48.7 mg) required higher doses of rescue analgesia (diclofenac sodium) than morphine soaked gelfoam (57 ± 39.2 mg). [ 18 ] Kundra et al [ 17 ] studied gelfoam morphine (5 mL of 1 mg.mL − 1 morphine) found reduced rescue analgesic morphine (8.47 ± 3.67 mg)) consumption in 48 h than group control (24.80 ± 6.009 mg). Hence, the use of gelfoam soaked opioids, dexmedetomidine, or bupivacaine was effective to reduce rescue analgesic consumption in postoperative period.…”

“…[ 16 ] Various other studies also found that gelfoam soaked epidural morphine in spine surgery can be prolonged duration of analgesia. [ 17 18 ]…”

“…[ 3 ] Morphine soaked gelfoam in epidural space showed lower mean VAS scores in lumber laminectomy patients. [ 17 18 ]…”