Effects of Caudal Epidural Pethidine on Pain Control and Early Mobilization after Posterior Spinal Instrumentation: A Randomized Controlled Trial.

Abstract

Aim: To evaluate the effects of administering pethidine (also known as meperidine), a long-acting narcotic analgesic, via the caudal epidural route at the conclusion of posterior lumbar instrumentation (PLI) surgery on postoperative pain control, and early mobilization of patients.

Material and methods: The cases included in this prospective study (n=48) were randomly divided into two groups, ensuring similar gender and age distributions and uniformity regarding lumbar pathologies requiring surgery. In the first group, 20 mL of sodium chloride (0.09%) solution containing pethidine chloride (0.5 mg/kg) was administered via a caudal epidural block before the patients were awakened from anesthesia. The control group consisted of cases in which the caudal epidural block was not performed using pethidine or any other pharmaceutical/pharmacological agent. Visual analog scale (VAS) pain assessments were performed in both groups preoperatively, postoperatively, and 24, 48, and 72 hours after awakening and recovery. Oral feeding at the sixth postoperative hour and mobilization at the eighth postoperative hour were evaluated in all cases. The data obtained were statistically analyzed with a significance level of ?=0.05.

Results: The VAS scores of cases administered with pethidine via a caudal block were found to be significantly lower at all measurement times compared with those without a caudal epidural block (p < 0.05). The need for analgesic medication in terms of dosage and duration was lower in the pethidine group during the postoperative period. Both groups began oral feeding at the sixth postoperative hour. The cases in the pethidine group were mobilized with ease at the eighth postoperative hour, whereas those without a caudal epidural block with pethidine could only be mobilized as early as the 24th postoperative hour.

Conclusion: Administering pethidine via a caudal epidural block before awakening at the conclusion of PLI surgery may provide benefits in postoperative pain control and early mobilization.