Continuous Low-dose Epidural Morphine and Ketamine Analgesia Improves Quality of Recovery after Major Lumbar Spine Surgery: A Randomised Controlled Trial.

Abstract

Objective: The effect of postoperative analgesia on the quality of recovery (QoR) after major lumbar spine surgery is understudied. We hypothesized that continuous epidural morphine and ketamine administration would provide effective analgesia, thereby improving QoR compared to continuous intravenous morphine and ketamine using the QoR-15 questionnaire.

Methods: A total of 40 patients were randomised to receive either continuous low-dose epidural morphine and ketamine via an intraoperatively placed epidural catheter (Group A) or intravenous morphine and ketamine using a patient-controlled analgesia system (Group B) for 48 hours. All patients were anaesthetized using standard anaesthesia drugs. The primary outcome was QoR at 24 and 48 hours after surgery using the QoR-15 questionnaire. The secondary outcomes were pain score at various time points during the first 48 hours, rescue analgesic requirements, ambulation time, length of hospital stay, and patient satisfaction.

Results: Forty patients were recruited (20 in each group), and all patient data were included in the analysis. The total QoR-15 scores for Group A and Group B at 24 hours were 134.8±6.65 and 128.9±6.12, respectively (P=0.006). The QoR-15 scores at 48 hours for groups A and B were 136.7±6.02 vs 132.10±6.8 (P=0.029), respectively. The pain score was lower in Group A than in Group B at rest and during movement, with P=0.015 and 0.001, respectively, and all the other secondary outcomes were comparable between the groups.

Conclusion: Postoperative analgesia with continuous low-dose epidural morphine and ketamine via an intraoperatively placed epidural catheter provides superior QoR after major lumbar spine surgery as compared to intravenous morphine and ketamine.