الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
Patients undergoing lumbar laminectomy experience
severe pain in the postoperative period, which may increase
the incidence of postoperative morbidity and
complications. Adequate pain relief hastens rehabilitation,
and decreases the incidence of chronic pain.
Adult caudal blockade has fallen from favor in the
anesthesia community. The majority of anesthesia
providers now use lumbar epidurals and spinals for
surgeries that can be done with caudals. Many claim the
procedure is difficult to perform and the outcome of the
block is unpredictable.
Stress responses associated with surgical trauma may
cause subtle changes in some vital and hormonal
parameters. increased plasma cortisol level and suppressed
anabolic hormones, such as insulin, may have deleterious
effects during the perioperative period.
Caudal bupivacaine and morphine administration has
been used for postoperative pain relief in lower abdominal
surgery, thoracotomy, and liver transplantation.
In this study, while general anesthesia is administered to
all patients undergoing lumbar laminectomy surgeries, we
evaluated and compared the efficacy of caudal image
guided epidural- bupivacaine or morphine administration at
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low concentrations that doesn’t cause any motor block on
the attenuation of the stress response during (intra) and
after (post) lumbar laminectomy surgeries.
Our results revealed that patients in the caudal
bupivacaine group (A) and caudal morphine group (B)
showed significantly lower intraoperative stress response to
surgery, postoperative pain scores, no postoperative motor
block with the concentration 0.125% of bupivacaine used,
lesser doses of postoperative rescue analgesics were needed
in comparison with patients in the the control group (C) for
24hrs, while the caudal morphine group (B) showed
significantly lower incidence of adverse effects like
delayed ambulation and urinary retention in comparison to
the caudal bupivacaine group (A).
Preemptive analgesia with a single caudal epidural
injection of morphine is a safe, simple and effective
technique giving postoperative pain relief for a period of up
to 24 hours. Prone positions adopted for posterior surgeries
on the lumbosacral spine and the ready availability of
image intensifiers during such surgeries make this
technique a very convenient and suitable one for such
surgeries.