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ESRA19-0535 The analgesic efficacy of ultrasound guided preemptive caudal morphine as an adjunct to bupivacaine for lumbosacral spine surgeries in adults: a randomized controlled trial
  1. AK Malviya1,
  2. S Chhavi1,
  3. C Anjolie1,
  4. DK Baidya1,
  5. A Kumar2 and
  6. MK Arora3
  1. 1AIIMS All India Institute of Medical Sciences, New Delhi, Department of Anesthesiology, Pain Medicine and Critical Care, New Delhi Ansari Nagar, India
  2. 2AIIMS All India Institute of Medical Sciences, Patna, Department of Anesthesiology, Pain Medicine and Critical Care, Patna, India
  3. 3ILBS, Institute of Liver and Biliary Sciences, Department of Anesthesiology, Pain Medicine and Critical Care, New Delhi, India


Background and aims The analgesic efficacy of preemptive administration of caudal morphine for spine surgeries in adults has never been reported in literature. Present study was designed as a double-blinded, randomized controlled trial to assess the safety and analgesic efficacy of preemptive, single-shot, ultrasound guided administration of caudal morphine and bupivacaine compared with caudal bupivacaine alone in lumbosacral spine surgeries.

Methods After Institutional Ethics Committee approval, 40 patients (18–60 yrs) (n=40) planned for lumbosacral spine surgery were randomized to study and control groups. After induction and prone positioning, ultrasound guided caudal drug(s) were administered 30 minutes prior to incision: morphine 50mcg/kg with 20 ml 0.25%bupivacaine in study group (MB), while only bupivacaine in control group (BU). Postoperatively, both groups received intravenous morphine via PCA pump (no basal, 1 mg/bolus, 10 minutes lockout interval). Intraoperative fentanyl use, postoperative 24-hr morphine consumption, VAS scores and adverse effects of morphine were noted.

Results Of the 40 randomized patients, 20 each included in the study (MB) and control (BU) groups, had comparable demographics, preoperative pain (VAS) and extensiveness of surgeries. Postoperative 24-hour morphine requirement and 2/4/6/12-hour VAS scores in study group (MB) were significantly less than control group (BU) (p=0.0001, p<0.05); while VAS scores were comparable at 18 and 24 hours (p=0.25,0.42) (Table 1, figure 1).

Abstract ESRA19-0535 Figure 1

Mean VAS scores in study groups at different time points.

Abstract ESRA19-0535 Table 1

Intraoperative and postoperative analgesia -

There was no statistically significant difference in total intraoperative fentanyl requirement (p=0.28) or postoperative incidence of adverse effects of morphine (respiratory depression, PONV, pruritus and urinary retention).

Conclusions Ultrasound guided, single-shot preemptive administration of caudal morphine with bupivacaine is a safe and effective modality of analgesia for patients undergoing lumbosacral spine surgeries.

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