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TIDD admixture of
fentanyl/bupivacaine showed a lower rate of opioid escalation with greater
safety than TIDD admixture of hydromorphone/bupivacaine.
As per the recent study findings, comparable pain relief was observed with targeted intrathecal drug delivery (TIDD) using a low-dose fentanyl admixture with bupivacaine and TIDD with hydromorphone and bupivacaine in patients suffering from postlaminectomy syndrome and chronic low back pain.
TIDD has already been established as an effective pain management method for patients suffering from postlaminectomy syndrome and refractory chronic back pain. Intrathecal bupivacaine is often combined with an opioid, but the use of morphine or hydromorphone has been associated with intrathecal catheter tip granulomas. No such effects have been noted with fentanyl. The present study aimed to find the comparative efficacy of TIDD using bupivacaine/fentanyl with bupivacaine/hydromorphone in postlaminectomy patients with refractory chronic low back pain.
This study was a retrospective comparative analysis. The patients with the lumbar postlaminectomy syndrome who were trialled and received bupivacaine/fentanyl or bupivacaine/hydromorphone at a single tertiary medical centre amid June 2009 and May 2016 were included in the study.
A total of 58 patients with lumbar postlaminectomy patients receiving either TIDD using low-dose fentanyl/bupivacaine (n=28) or TIDD using hydromorphone/bupivacaine (n=30) with a minimum follow-up of 2 years were identified. Similar and considerable decrease in pain scores was noted in both the groups. However, in the fentanyl group, a significant reduction in baseline opioid consumption and intrathecal opioid dose escalation was observed. Granulomas was absent in the study population.
Pain Medicine
Comparative Effectiveness of Targeted Intrathecal Drug Delivery Using a Combination of Bupivacaine with Either Low-Dose Fentanyl or Hydromorphone in Chronic Back Pain Patients with Lumbar Postlaminectomy Syndrome.
Ade T et al.
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