ORIGINAL ARTICLES  ANTALGIC THERAPY Free access

Minerva Anestesiologica 2002 January-February;68(1-2):55-63

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: Italian

Continual epidural therapy in lumbosciatic syndrome. Personal experience

Maratea N.

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.