Comparison of Epidural Morphine Soaked Gel Foam and Continuous Intravenous Morphine Using PCA in the Management of Postoperative Pain Following Lumbar Spinal Fixation Surgery

Background: Pain management can be a major challenge after spinal surgery. The useof parenteral opioids has been the mainstay of analgesia for patients undergoingposterior lumbar spinal surgery. The route of opioid administration can be epidural,intrathecal, intramuscular (IM), or intravenous (IV), or opioid administration can be inthe form of a continuous infusion or as patient-controlled analgesia (PCA) with orwithout background infusions. Intravenous or IM administration of opioids is associatedwith dose-dependent side effects such as respiratory depression, nausea and vomiting,sedation, and gastrointestinal ileus. Aim of the study: to compare the analgesic effect ofepidural morphine soaked Gelfoam with that of continuous intravenous morphine usingPCA following lumber spinal fixation surgery. Patients and Methods: A prospectivenon-randomized controlled trial of 100 cases of spinal fixation surgery of at least onemotion segment of the lumbar spine was involved. Patients were divided into 2 groups.Group one included 50 patients who underwent placement of gel foam soaked with 1 MLof 0.1% morphine. Group two, included 50 patients as well, with intravenous patientcontrolled analgesia set. Results: Our patient population included 33 females and 67males. The mean age at time of operation was 48.2 in group 1(the youngest was 30 andthe oldest was 56) and 47.1 in group 2 (the youngest was 28 and the oldest was 59).There was no procedure related morbidity or mortality in the series. 62 cases includedfusion of one motion segment, 38 cases included fusion of 2 motion segments. We hadstatistically comparable results for pain control in both groups. There has not beenstatistically significant difference in the pain control between both groups in the first 48hours. No correlation has been found between the levels operated upon or the number oflevels operated and the pain control or the failure in both groups. No correlation wasfound between the sex and the ages of the patients and the pain control or failures.Conclusion: We conclude that the use of morphine soaked Gelfoam® placed epidurallyfollowing spinal surgery is an effective analgesic method. The results are compared tointravenous continuous infusion of morphine with fewer side effects, and lower cost.