Morphine and morphine + application of preemptive lumbar paravertebral somatic block in postlaminectomy pain

Aim: Administration of Morphine with Intravenouse PCA is a routine process in postoperative pain relief on laminectomy. İn this study, we aimed to evaulate the effect of preemptive paravertebral somatic block with levobupivacaine on postoperative morphine consumption.Matherial and Method: After approval of Faculty Ethical Commitee and patient consent, aged 20-70, ASA I-II, 100 patients who are undergoing laminectomy were included. Patients randomly divided into two groups:Group I patients were recieved 0,1 mg/kg iv. boluse mophine 20 minutes before the end of operation and iv. PCA morphine (40 mg morphine in 100 ml isotonic saline, PCA demand dose 0,02 mg/kg, 20 min lockout time) was started after the operation.Group II patients who are placed prone position after intubation, bilateral paravetrebral somatic block was performed with 5 ml levobupivacaine 0,5 % for each nerve to upper dermatome of laminectomy level. Intravenouse PCA morphine was started after the end of operation. All patient were recieved 8 mg ondansetron for antiemesis.Postoperative systolic and diastolic blood pressures, heart rate, SpO2 values, pain (VAS) scores, total morphine consumption and side effects were recorded.Results: Demografic data, operation times and hemodynamic parameters of groups were similar. VAS scores were higher in group I than group II on postoperative 4., 6., 12. h (p<0,05). Total morphine consumption was recorded as 29,46±9,34 mg in group I and 11,88±7,28 in group II for 24 hours. Total morphine consumption was significantly lower in group II than group I (p<0,05).Conclusion: We concluded that the application of preemptive lumbar paravertebral somatic block with levobupivacaine reduce morphine requirement, provide more efficient analgesia, without change hemodynamic parameters and side effects.Key words: Laminectomy, Lumbar Paravertebral Somatic Block, Morphine, Patient Controlled Analgesia, Preemptive Analgesia