In this randomized clinical trial, 68 patients with American Society of Anesthesiologists (ASA) I or II undergoing lower abdominal surgery were randomly assigned to have elective lower abdominal surgery under SA (n = 34) or
GA (n = 34). The SA group received 3 cc of 0.5% hyperbaric
bupivacaine (15 mg), at L3-L4 interspace intrathecally and also 2 mic/kg
fentanyl and 0.15 mg/kg
morphine intravenously for intraoperative
analgesia. In the GA group, induction of
anesthesia was carried out with Na
thiopental 6 mg/kg
body weight,
fentanyl 2 mic/kg
body weight,
morphine 0.15 mg/kg, and
atracurium 0.6 mg/kg
body weight, and then, trachea was intubated. The primary outcome was
postoperative pain scores at rest and under stress on a visual analog scale and the secondary outcome was
morphine requirement by the patients. Outcome measures were recorded at 2, 4, 6, 12, and 24 h postoperatively. The duration of postanesthesia care unit (PACU) and
hospital stay were recorded. Intraoperative parameters,
postoperative pain scores, complications, recovery time, and the duration of
hospital stay at follow up were compared between the two groups.
RESULTS: Patients in SA group had significantly lower scores of a
postoperative pain at rest (3.4 ± 1.6 and 4.1 ± 1.2 at 2 and 4 h postoperatively vs. 5.2 ± 1.5 and 5.8 ± 0.9 in the GA group with P < 0.05), but there were no significant differences between both groups for scores of
postoperative pain at 6, 12, and 24 h. The amount of
morphine requirement in 6 h postoperatively was significantly lower in the SA group (10.2 ± 4.3 mg vs. 15.6 ± 5.6 mg in the GA group with P < 0.05), but there were not significant differences between the two groups after 6 h postoperatively. The duration of PACU stay was shorter for the GA group than the SA group (75 ± 6 vs. 126 ± 12 min, P < 0.001), but there was no significant differences between the duration of
hospital stay between the two groups (1.8 ± 0.6 vs. 2.1 ± 0.8 days).
CONCLUSION: Although in patients undergoing elective lower abdominal surgery with SA may have lower
pain scores and also lower
morphine requirement in the first 6 h postoperatively, but after that there were no significant differences between SA and GA regarding
postoperative pain scores and
analgesic requirements and so more attention should be given to their postoperation
pain relief.