Difference in analgesia following epidural blockade in patients with postoperative or chronic low back pain

• Published in: Pain (Amsterdam) Vol. 34; no. 1; pp. 21 - 27
• Main Authors: Raj, P.Prithvi, Knarr, Donna, Vigdorth, Ellen, Gregg, Richard V., Denson, Donald D., Edström, Hakan H.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier B.V 01.07.1988; Elsevier
• Subjects: Acute pain; Adult; Aged; Analgesia; Anesthesia, Epidural; Anesthetics. Neuromuscular blocking agents; Back Pain - therapy; Biological and medical sciences; Bupivacaine; Chronic pain; Continuous epidural analgesia; Female; Humans; Local anesthetic; Male; Medical sciences; Nerve Block; Neuropharmacology; Pain, Postoperative - therapy; Pharmacology. Drug treatments; Postoperative pain; Local anesthetic; Continuous epidural analgesia; Postoperative pain; Bupivacaine; Acute pain; Chronic pain; Therapeutic efficiency; Extradural; Human; Analgesia; Chronic; Nervous system diseases; Pain; Perfusion; Acute; Interindividual comparison; Comparative study
• ISSN: 0304-3959; 1872-6623
• DOI: 10.1016/0304-3959(88)90177-7

Subjective responses of continuous epidural analgesia with bupivacaine were compared in 30 patients with acute (postoperative) or chronic (low back) pain. In the acute pain patients, sensory block was 4 dermatomes at 9 h and 6 dermatomes at 64 h. Corresponding values in the chronic pain patients were 8 and 6 dermatomes respectively. Motor blockade of the lower limbs was more profound in the acute pain group. The acute pain patients had significantly better pain relief (VAS: 85–96% vs. 55–70%) and a significantly higher proportion of these patients reported a global score of 3 (excellent; 80% vs. 7%). The mean dosage of bupivacaine decreased in the acute pain group from 21.0 ± 5.7 (mean ± S.D.) mg/h at 9 h to 15.1 ± 8.5 mg/h at 64 h. Corresponding values for the chronic pain group were 20.7 ± 5.9 and 12.0 ± 6.0 mg/h respectively. Mean plasma concentration of bupivacaine increased from 1.2 ± 0.8 μg/ml at 9 h to 2.1 ±1.4 μg/ml at 64 h in the acute pain patients and was 0.8 ± 0.3 μm/ml at 9 h to 1.0 ± 1.0 μg/ml at 64 h in the chronic pain patients. The incidence of side effects was approximately the same in both groups. No signs of accumulation or toxic reactions to bupivacaine were seen.