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A Journal on Anesthesiology, Resuscitation, Analgesia and Intensive Care
ORIGINAL ARTICLES ANTALGIC THERAPY
Minerva Anestesiologica 2002 January-February;68(1-2):55-63
Continual epidural therapy in lumbosciatic syndrome. Personal experience
ASL n. 5 - Montalbano Ospedale Policoro (Matera) Responsabile del Servizio (Dott. E. Calculli)
Background. The purpose of this retrospective study was to evaluate the effects of associating several currently used drugs: local anesthetics, corticosteroids, morphine hydrochloride and clonidine administered using continual epidural in lumbosciatic back pain. The association of an opiate and a solution of local anesthetic through infusion increases the analgesic effect and allows smaller quantities of both drugs to be used. The addition of another drug, like clonidine, may allow the dose of the single drugs to be reduced even further, thus resulting in fewer dose-dependent side effects. We know that at least two of the opiate receptor systems and at least three non-opiates modulate the painful sensory afferences. The cortisones can act as both antiphlogistics and antiedemigens, as well as inhibition prostaglandin.
Methods. All the patients in this study were hospitalised after varying periods of home therapy or in other wards. The case histories of 462 patients were studied on admission using routine X-rays and laboratory tests, and also based on a chart divided into parts: the first showed the marks for EO of a patient with lumbosciatica, and the second contained pain-related data. This was measured both directly, using the Scott-Huskisson visual parallel and a language card, and indirectly (possible activities, drug intake, etc.). The scale of the analog used defines slight pain with values of less than 44 mm, moderate pain with values between 45-69 mm, strong pain with values between 70-88 mm, and very strong pain above 88 mm.
Results. The following results were obtained from this study: successes 87.9%, partial successes 1.7%, failures 10.3%. Of the 48 failures, 31 were operated within a few days, whereas the remaining 17 cases were not operated because the patients declared that they were satisfied with the improvement obtained or gave other reasons. The analgesic effect was frequently observed. The improvement usually increased after the second block so that some patients did not require a third administration.
Conclusions. The results confirm that continual epidural therapy is the most successful and also the most rapid treatment available for pain of lumbar origin. At present we share Finneson’s opinion that the same general indications are still valid: 1) discopathy with negative NMR; 2) discopathy with medical contraindications to surgery; 3) discopathy of lumbar and/or radicular origin with alterations to multiple NMR and no reliable signs of a specific root; 4) for symptomatic purposes while waiting for diagnosis and surgery.