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  • Title: Difference in analgesia following epidural blockade in patients with postoperative or chronic low back pain.
    Author: Raj PP, Knarr D, Vigdorth E, Gregg RV, Denson DD, Edström HH.
    Journal: Pain; 1988 Jul; 34(1):21-27. PubMed ID: 2970056.
    Abstract:
    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 micrograms/ml at 9 h to 2.1 +/- 1.4 micrograms/ml at 64 h in the acute pain patients and was 0.8 +/- 0.3 micrograms/ml at 9 h to 1.0 +/- 1.0 micrograms/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.
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