Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

Arirachakaran, Alisara; Siripaiboonkij, Montree; Pairuchvej, Saran; Setrkraising, Kittipong; Pruttikul, Pritsanai; Piyasakulkaew, Chaiwat; Kongtharvonskul, Jatupon

doi:10.1007/s00590-018-2229-4

Cited by 12 publications

(18 citation statements)

References 25 publications

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“…However, the other studies reported a positive effect of steroids on pain. Four previous meta-analyses were published [ 18 – 21 ] ; 2 meta-analyses reported that intraoperative ESI when compared to placebo was effective in reducing pain in the early stage and reducing consumption of analgesia with no statistically significant differences in terms of overall complications and infection in lumbar discectomy. [ 18 , 19 ] One meta-analysis reported that intraoperative ESI application offers some benefits in pain control with a significant reduction in the length of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

“…[ 20 ] The most recent meta-analysis indicated a lower back and leg pain score, decreased morphine consumption, and shorter hospital stay without difference in complications for ESI application compared to placebo after lumbar discectomy in lumbar disc herniation that was not detected in previous meta-analyses. [ 21 ] However, these meta-analyses still have many limitations.…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation

Cai

Jiang²,

Qiu³

et al. 2020

Medicine

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Background: Concerns exist regarding the analgesia effect and safety of epidural steroid injection (ESI) after discectomy. There is an urgent need of studies that efficiently control for confounding, conduct comprehensive and consecutive observation of potential risks of ESI, and investigate its clinical applicability. We thus further designed a randomized controlled study to assess the efficacy of ESI on postoperative pain and complications in patients undergoing unilateral lumbar microdiscectomy. Methods: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the Committee at the No.2 People's Hospital of Yibin. All procedures were performed by a single surgeon and informed consent was obtained from each patient. Ninty eligible patients diagnosed at our institution with herniated lumbar disc during a period from June 2020 to July 2021 will be assessed. Group 1 was a mixture of 1 mL of 0.5% bupivacaine and 10 mg of triamcinolone acetonide in 1 mL. Group 2 was a mixture of 1 mL of 0.5% bupivacaine and 1 mL of normal saline. The primary outcome measure was the amount of morphine consumption from a patient-controlled analgesia pump at 12, 24, and 48 hours after surgery. The following secondary outcomes were also assessed: postoperative pain score, back pain score, functional disability, and adverse effect. Conclusions: We hypothesized that the ESI was associated with lower pain score, morphine consumption, and hospital stay, with no significant difference in complications for ESI application after lumbar discectomy in lumbar disc herniation when compared with placebo. Trial registration: This study protocol was registered in Research Registry (researchregistry5683).

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation

Cai

Jiang²,

Qiu³

et al. 2020

Medicine

View full text Add to dashboard Cite

show abstract

“…Arirachakaran et al in his meta-analysis of use of epidural local steroid after discectomy showed decreased consumption of opioids in postoperative phase. 8 There was no difference in the complications between steroid and placebo group. Devi et al in his study of 61 patients with intraoperative use of steroid after lumbar discectomy found significant pain relief during postoperative days with less use of opioids but there was no difference in pain on long run and there was no difference in the complication rate.…”

Section: Discussionmentioning

confidence: 82%

Retrospective Analysis of Clinical Outcome of Intraoperative Epidural Steroid Injection Versus No Steroid Injection after Standard Lumbosacral Discectomy

Pandey

Bidari

2020

J Coll Med Sci-Nepal

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Background: Despite operative decompression of neural structure with discectomy in the indicated cases of lumbosacral disc herniation, many patients continue to experience back pain and leg pain in the postoperative period. Use of intraoperative local epidural steroid injection has been in practice to reduce this complications but there are concern and controversies regarding its benefit and risk. So this study aims to analyze clinical outcome in terms of reduction in pain, hospital stay, postoperative use of analgesics and risk associated with the use of intraoperative epidural steroid locally and comparison to those who did not receive steroid. Methods: This was a retrospective analysis of total of 44 patients, 28 patients who received Epidural Steroid Injection (ESI) locally after lumbosacral standard discectomy and comparison of the outcome with results of 16 patients with standard lumbosacral discectomy who did not receive ESI. Outcome measurement was done between two groups in terms of postoperative pain VAS scale, use of analgesics, hospital stay and complications if any. Results: There were total of 44 cases (28 steroid group and 16 no steroid group) with mean age of 39.93 years, male 27 and female 17 who underwent standard discectomy and followed up for at least one year. Overall, preoperative mean VAS score for pain improved from 7.95 to 1.55 at 1 year after operation which was significant p<0.05. On comparison of 24 hour postoperative VAS score and hospital stay between the groups with steroid and no steroid, it was mean of 5.32 versus 6 and 4.43 days versus 5.25 days (p<0.05) respectively which was significant. All the patients in no steroid group needed both NSAID and opioids for the postoperative pain management whereas only 12 (42.8%) patient needed addition of opioids in steroid group. There was no difference in VAS score at 1week and 1 year. There was no complications in either of the group. Conclusions: Use of intraoperative ESI help to reduce early postoperative pain, hospital stay and use of opioids without adding further risk or complication.

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“…Re.view of randomized control trials by Waqas favored intra operative use of steroids for lumbar disc surgery as it did improve pain in the post-operative period with fewer complications 14 . In spite of reported benefits including earlier mobilization, reduced requirement of post-operative pain killers and earlier discharge from the hospital, the technique is not employed routinely amongst the neurosurgeons 15 . One possible reason is that the efficacy is still controversial and is supported by subjective measures of outcome improvement only 16 .…”

Section: Discussionmentioning

confidence: 99%

Efficacy of Intra Operative Use of Triamcinolone in Lumbar Discectomy

Ishfaq

Shahzad

2020

PAFMJ

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Objective: To evaluate the effect of epidural application of triamcinolone during lumbar discectomy onpostoperative pain relief. Study Design: Case control study. Place and Duration of Study: Department of Neurosurgery, Combined Military Hospital Lahore, from Oct 2019to Feb 2020. Methodology: Thirty patients receiving intraoperative epidural triamcinolone application compared with30 controls objective assessment by T-scores of the Timed Up and Go test, back and sciatic leg pain by Visualanalog scale and for subjective functional impairment by oswestry Disability Index were calculated pre-op, postoperative day 2 and at 4 weeks. Results: The baseline demographics, disease specific features and preoperative impairment scores were similaramong both groups. At day post-operative day 2, subjective impairment on oswestry disability index for thesteroid group was (30.6 vs 36.2, p<0.01), with significant difference in terms of objective functional impairmentscore between steroid group (T-score 128.2 vs 129.3, p<0.01). At 4 weeks post operatively, the Objective functional impairment was also found to be significantly less in the steroid group (T-score 100.5 vs 110.3, p<0.01), with less disabled steroid group patients with oswestry disability index (17.0 vs 24, p<0.01). Complication rates in both groups were similar. The duration of hospital stay was shorter among the steroid group (5.0 vs 5.8 days, p=0.06). Conclusion: The application of triamcinolone in lumbar discectomy leads to benefit in both subjective andobjective pain parameters in the early postoperative period.

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Comparative outcomes of epidural steroids versus placebo after lumbar discectomy in lumbar disc herniation: a systematic review and meta-analysis of randomized controlled trials

Cited by 12 publications

References 25 publications

Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation

Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation

Retrospective Analysis of Clinical Outcome of Intraoperative Epidural Steroid Injection Versus No Steroid Injection after Standard Lumbosacral Discectomy

Efficacy of Intra Operative Use of Triamcinolone in Lumbar Discectomy

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