Egyptian Journal of Neurosurgery Volume 29 / No. 3 / July - September 2014 67-72 Egyptian Journal of Neurosurgery 67 Original Article Comparison of Epidural Morphine Soaked Gel Foam and Continuous Intravenous Morphine Using PCA in the Management of Postoperative Pain Following Lumbar Spinal Fixation Surgery 1 Khaled Saoud*, 1 Hatem Sabry, 2 Osama Ramzy 1 Department of Neurosurgery, Ain Shams University 2 Department of Anesthesiology, Ain Shams University ARTICLE INFO ABSTRACT Received: 2 June 2014 Accepted: 9 September 2014 Key words: Spinal fixation, Postoperative analgesia, Morphine, Gelfoam Background: Pain management can be a major challenge after spinal surgery. The use of parenteral opioids has been the mainstay of analgesia for patients undergoing posterior lumbar spinal surgery. The route of opioid administration can be epidural, intrathecal, intramuscular (IM), or intravenous (IV), or opioid administration can be in the form of a continuous infusion or as patient-controlled analgesia (PCA) with or without background infusions. Intravenous or IM administration of opioids is associated with dose-dependent side effects such as respiratory depression, nausea and vomiting, sedation, and gastrointestinal ileus. Aim of the study: to compare the analgesic effect of epidural morphine soaked Gelfoam with that of continuous intravenous morphine using PCA following lumber spinal fixation surgery. Patients and Methods: A prospective non-randomized controlled trial of 100 cases of spinal fixation surgery of at least one motion segment of the lumbar spine was involved. Patients were divided into 2 groups. Group one included 50 patients who underwent placement of gel foam soaked with 1 ML of 0.1% morphine. Group two, included 50 patients as well, with intravenous patient controlled analgesia set. Results: Our patient population included 33 females and 67 males. The mean age at time of operation was 48.2 in group 1(the youngest was 30 and the oldest was 56) and 47.1 in group 2 (the youngest was 28 and the oldest was 59). There was no procedure related morbidity or mortality in the series. 62 cases included fusion of one motion segment, 38 cases included fusion of 2 motion segments. We had statistically comparable results for pain control in both groups. There has not been statistically significant difference in the pain control between both groups in the first 48 hours. No correlation has been found between the levels operated upon or the number of levels operated and the pain control or the failure in both groups. No correlation was found between the sex and the ages of the patients and the pain control or failures. Conclusion: We conclude that the use of morphine soaked Gelfoam ® placed epidurally following spinal surgery is an effective analgesic method. The results are compared to intravenous continuous infusion of morphine with fewer side effects, and lower cost. © 2014 Egyptian Journal of Neurosurgery. Published by MEDC. All rights reserved INTRODUCTION Pain management can be a major challenge after spinal surgery. The alleviation of postoperative pain is primarily provided for humanitarian reasons, but also to reduce no ciception-induced responses, which may adversely influence organ functioning and contribute to morbidity. 1,2 Pain may obviously be considered as another neurophysiological response to surgery but with its own secondary effects on biological functions. Pain *Corresponding Author: Khaled M F Saoud Department of Neurosurgery, Ain Shams University Email: khaled.saoud@gmail.com , Tel.: +2/01222441039 amplifies the metabolic response, autonomic reflexes, ileus, and nausea and delays mobilization and feeding. Effective treatment of postoperative pain, therefore, results in modification of the biological response to surgery, but the extent of modification is dependent on the choice of analgesic technique. 3 The use of parenteral opioids has been the mainstay of analgesia for patients undergoing posterior lumbar spinal surgery. The route of opioid administration can be epidural, intrathecal, intramuscular (IM), or intravascular (IV), or opioid administration can be in the form of a continuous infusion or as patient-controlled analgesia (PCA) with or without background infusions. Intravenous or IM administration of opioids is associated with dose-dependent side effects such as