Indwelling epidural morphine for control of post-lumbar spinal surgery pain

The epidural instillation of morphine for pain control has been utilized for some time, although primarily intraoperatively or for patients with chronic severe pain, as in terminal cancer. Long term indwelling catheter or subarachnoid administration of epidural morphine are both potentially hazardous. However, in relatively brief applications, up to a few days, the epidural administration of morphine sulfate Is effective, safe, and well tolerated when used according to a carefully controlled plan. We report the use of this method as an improved means for the control of post-lumbar surgery pain in 25 cases. These patients were compared with 25 others receiving standard doses of parenteral and oral narcotics. The two groups were quite similar preoperatively. However, patients receiving epidural morphine were more comfortable, had fewer side effects such as nausea and lassitude, and exhibited no respiratory depression. Further, they ambulated sooner, showed no definitive orthostatic hypotension and less ileus, and remained much more alert and cooperative during the initial 48 hours after operation. Hospitalizations were usually shorter by 1 or 2 days. The administration of very small doses (1.0 to 2.5 mg) of morphine every 12 to 24 hours was usually adequate for good to excellent postoperative pain control. Hydroxyzine was sometimes used to potentiate the analgesia between doses. The epidural catheters were routinely removed within about 72 hours. The technique for the intraoperative placement of the epidural catheter and drug administration are detailed. Precautions for catheter placement were carefully followed to prevent dural penetration or intrathecal injection.