Abstract
Background: Better postoperative pain, functional outcomes and patient satisfaction have been reported using spinal anaesthesia when compared with general anaesthesia.
However, higher levels of urinary retention with spinal anaesthesia can lead to delayed discharge in microdiscectomy surgery.
Anecdotally, we believe that further improvements to patient satisfaction and a reduction in the need for urinary catheterisation can be found in patients receiving fentanyl intrathecally as opposed to morphine.
Methods: Seventy consecutive patients were recruited and prospectively randomised into two equal groups, with half the patients receiving intrathecal fentanyl with the spinal anaesthetic and the remainder receiving morphine.
A comprehensive post operative evaluation was carried out documenting any anaesthetic complications, post operative analgesic requirement, physiological and functional recovery, need for urinary catheterisation and patient satisfaction.
Results: Both groups were equally matched for age and gender. Mean age was 43 years in fentanyl group and 50 years in the morhhine group. All patients were discharged on day one post surgery. 3 patients in the fentanyl group and 11 patients in the morphine group required urinary catheterisation.
No intra-operative anaesthetic or surgical complications were noted.
Mean Visual Analogue score for pain was lower in the fentanyl group [2.46] compared to morphine group [2.70].
Conclusion: Lumbar spinal microdiscectomy can be safely performed as a short stay procedure under spinal anaesthesia using intrathecal fentanyl or morphine. Post-operative pain and functional out comes were comparable between the two groups but lower incidence of post-operative nausea, vomiting, itching and urinary catheterisation can be expected with use of fentanyl
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