Epidural droperidol and morphine for postoperative pain

Epidural morphine is effective in the treatment of postoperative pain, but the incidence of associated side effects is high. To assess a potential reduction of opioid side effects by droperidol, 4 mg morphine with either placebo or 2.5 mg droperidol was injected epidurally in a double-blind, randomized, postoperative trial. Forty patients undergoing hip replacement surgery were studied. The overall incidence of side effects during the first 24 h in the group receiving droperidol and morphine was less than 50% of that in the group receiving placebo and morphine (P less than 0.008). Pruritus, emesis, nausea, urinary retention, and hypotension were diminished in the group with droperidol. No significant differences in duration or quality of analgesia were seen. Epidural injection of droperidol did not result in any local or systemic side effects.

[Headache following spinal anesthesia: also a problem of the local anesthetic used?]

In a prospective clinical study we followed 320 patients operated upon in spinal anesthesia. We were especially interested in headache patterns after spinal anesthesia and their causes, with particular reference to the local anesthetic used. Apart from the typical postspinal headache due to low cerebrospinal fluid (CSF) pressure, we found a nontypical pattern which was considerably more prevelant than the classical type. The typical postspinal headache correlated well with procedures (multiple perforations, thicker cannulae) that lower or prolong the reduction of CSF pressure and a history of migraine. The nontypical headache correlated with the use of lignocaine/articaine for spinal anesthesia, possibly due to metabolic and structural factors.

[Backache following spinal anesthesia--a neglected problem?]

In a prospective clinical study we followed up 697 patients operated upon under spinal anaesthesia to determine the incidence of, and the factors predisposing to, post-spinal backache. The incidence of post-spinal backache, which occurs in approximately one in seven patients (13.1%) is comparable to that of post-spinal headache. This often neglected additional cause of post-spinal morbidity can be reduced by the use of atraumatic techniques and with small-gauge spinal needles for performing lumbar puncture.