الفهرس 
Caudal Epidural AnesthesiaOnly 14 pages are availabe for public view
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Abstract
Summary
T
he surgical management of a prolapsed lumbar disc was first described by Mixter and Barr (Mixter and Barr, 1934) in 1934. Less invasive procedures are commonly performed, leading to reduced recovery time and early discharge home from the hospital, which also leads to financial considerations in terms of cost savings. Micro-discectomy for herniated lumbar intervertebral disc has been proven to be clinically superior to more conventional methods when performed as an outpatient procedure. Both general and regional anesthesia have been used for elective lumbar disc surgical procedures; however, in epidural anaesthesia, there was less risks of GA complication, fewer fluctuations in heart rate and blood pressure that needed any intervention from the anaesthesiologists. Patients experienced less nausea and vomiting. The total blood loss due to surgery was also significantly less. In addition to reporting less peak pain postoperatively, patient satisfaction was better in the epidural group.
The aim of this study is to compare the intra-operative and short-term post-operative outcome variables in patients undergoing primary single-level lumbar discectomy under combined caudal epidural with general anaesthesia versus general anaesthesia alone.
After obtaining the approval of the local medical ethical committee and obtaining informed patient consent, 100 patients undergoing single-level lumbar discectomy were enrolled in this study. Patients were allocated into two groups randomly: group A (n=50) and group B (n=50).
After preoperative assessment and obtaining baseline vital data, all patients received general anaesthesia. Patients in group B received caudal epidural with 20ml of Bupivacaine 0.25%.
The two groups were adequately monitored and assessed post-operatively and they were compared regarding demographic data, hemodynamic, post-operative pain using VAS score, time for first analgesia, intraoperative analgesic consumption, blood loss and PONV.
Regarding hemodynamic parameters, there was statistically highly significant decrease of MAP and HR in group B compared to MAP and HR in group A, while there was no statistically significant difference between them regarding SpO2. There was statistically highly significant increase regarding intraoperative narcotic consumption in group A compared to group B. There was statistically significant decrease regarding intraoperative blood loss in group B compared to group A. There was statistically highly significant decrease in group A compared to group B in term of post-operative time for first time rescue analgesia, where it was significantly lower in group A compared to group B. There was statistically highly significant decrease regarding post-operative VAS score in group B compared to group A. There was statistically significant increase in group A compared to group B regarding postoperative nausea and vomiting (PONV).
This study concluded that combined caudal epidural with GA is safe and has benefits over GA alone for single leveled lumbar discectomy regarding intraoperative vital data (in terms of lower mean arterial blood pressure and lower heart rate), less intraoperative narcotic consumption, less intraoperative blood loss, less postoperative nausea and vomiting and less postoperative pain.