Pharmacological strategies to reduce pruritus during postoperative epidural analgesia after lumbar fusion surgery - a prospective randomized trial in 150 patients

150 patients (87 women) treated with posterior instrumented lumbar fusion were included. The mean age was 51 +/- 11 years. 76 were randomized to bupivacain, epinephrine and fentanyl (group B) and 74 to ropivacain and oxycodone (group R). Pruritus, motor block and pain were measured 6 hours after surgery, thereafter 6 times per day for 5 days. Any pain breakthrough episode was registered whenever it occurred.The epidural treatment could be performed in 143 patients (72 in group B and 71 in group R). Disturbing pruritus occurred in 53 patients in group B compared to 12 in group R (p < 0.0001). Motor blockade was most frequent on day 1, occurring in 45% of the patients with no difference between the groups. Both regimes gave good pain control with average VAS under 40, but the pain relief was statistically better in group B. The number of pain breakthrough episodes did not differ between the groups.Pruritus could be reduced with a combination of epidural ropivacain and oral oxycodone, at the price of a slightly higher pain level. Ropivacaine was not found to be superior to bupivacaine with regard to motor blocks.The postoperative pain level after posterior instrumented lumbar spine fusion surgery is generally high, thus an efficient pain control regime is required. Continuous epidural analgesia (CEA) with bupivacain, epinephrine and fentanyl for three days followed by oral analgesics is an effective postoperative treatment option [1,2]. This regime has been used successfully for many years, but pruritus and motor blocks are frequently encountered side effects. Pruritus is considered to be caused by epidural administration of opiates [3,4]. Unbearable pruritus leads to an early termination of CEA in multiple cases exposing the patients to an increased risk of a pain breakthrough before the alternative pain regime has reached its full effect. Furthermore, any paresis in the postoperative period after spine surgery has to be distinguished from a serious complication to th