Dexamethasone: Can it be an analgesic after lumbar laminectomy?

Dikmen, Bayazıt; Taspinar, Vildan; Karakelle, Nursel; Baydar, Mustafa; Pala, Y.; Günbey, M; Akdemir, Gökhan

doi:10.1163/1568569054729634

Cited by 5 publications

(8 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Spinal fusions were performed in 1 trial only. 23 In 5 trials epidural methylprednisolone was administered at a dosage of 80 mg; 6,15,22,23,31 in 5, epidural methylprednisolone was administered at a dosage of 40 mg; 27,29,34,35,43 in 1 trial epidural dexamethasone was administered at 8 mg; 7 and in 1, epidural dexamethasone was administered at 4 mg. 1 In 6 trials cointervention analgesia was used, 15,22,23,31,34,35 with bupivacaine, morphine, or steroids administered intravenously. Three trials compared epidural steroids to both an inactive and active control 15,29,34 and 1 trial 34 included 2 groups receiving epidural steroids.…”

Section: Resultsmentioning

confidence: 99%

“…2). 1,7,15,22,29,35,43 There was a trend toward benefit with epidural steroids at all time points. The SMD was statistically significant at 12-24 hours postoperatively (SMD -1.26, 95% CI -2.35 to -0.0.18, p = 0.02), but not at Day 2, 1 week, or 1-2 months postoperatively.…”

Section: Painmentioning

confidence: 90%

“…5 and Table 4). 7,15,22,23,27,34,35 The results showed significantly less analgesic medication consumed in the groups of patients treated with epidural steroids (SMD -0.38, 95% CI -0.62 to -0.14, p = 0.002). There was moderate heterogeneity (I 2 = 39%).…”

Section: Postoperative Consumption Of Analgesic Agentsmentioning

confidence: 92%

“…3 and Table 4). 7,15,22,29,43 There was a benefit with epidural steroids at 1 week postoperatively (SMD -0.71, 95% CI -1.19 to -0.24, p = 0.003) and 1-2 months postoperatively (SMD -2.14, 95% CI -3.47 to -0.81, p = 0.002), but not at 1 day or 2 days postopera-tively. The results of sensitivity analyses performed without the study of Hurlbert et al, 1999, 22 in which any pain and not radicular pain was reported, were not statistically significant.…”

Section: Painmentioning

confidence: 98%

“…The results of sensitivity analysis without Ang et al 1988, 1 a study in which ordinal scores were transformed into continuous scores, were not statistically significant. Statistical significance was maintained in the sensitivity analyses without the studies by Hurlbert et al, 22 Dikmen et al, 7 in which any pain-not specifically back pain-was reported, or without the study by Glasser et al, 15 in which ordinal scores were transformed into continuous scores.…”

Section: Painmentioning

confidence: 99%

See 4 more Smart Citations

Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Ranguis

Webster

2010

SPI

View full text Add to dashboard Cite

There is evidence that epidural steroids decrease pain in the short term and shorten length of stay in adults undergoing lumbar spinal surgery for degenerative spinal disease. Most of the evidence comes from studies without validated outcomes and that selectively report positive results. More research is required before establishing perioperative epidural steroids as an effective adjunct to surgery for reducing pain in the long term.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Painmentioning

confidence: 90%

Section: Postoperative Consumption Of Analgesic Agentsmentioning

confidence: 92%

Section: Painmentioning

confidence: 98%

Section: Painmentioning

confidence: 99%

See 3 more Smart Citations

Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Ranguis

Webster

2010

SPI

View full text Add to dashboard Cite

show abstract

Epidural Steroids at Closure After Microdiscectomy/Laminectomy for Reduction of Postoperative Analgesia: Systematic Review and Meta-Analysis

Wilson-Smith

Chang

et al. 2018

World Neurosurgery

View full text Add to dashboard Cite

Methylprednisolone Following Minimally Invasive Lumbar Decompression

Florence

Say

Rivera

et al. 2023

Spine

View full text Add to dashboard Cite

Study Design. Prospective randomized. Objective. Intraoperative methylprednisolone is a common adjunct following microscopic laminectomy/microdiscectomy. The goal of epidural instillation is a rapid symptomatic reduction in irritation of neural elements. There is inconsistent data supporting its use intraoperatively. To understand whether this maneuver results in any clinical effect, we performed a multiyear prospective study. Summary of Background Data. Previous work has demonstrated equivocal effects on pain with a suggestion of an increased risk of complication. These studies tend to suffer from small sample sizes and short follow-ups. Materials and Methods. Study obtained IRB approval. During the study period from 2013 to 2019, nearly equivalent numbers of patients who had received steroids during MIS decompressions were followed. Primary outcomes included pain (visual analog scale) and disability [Oswestry Disability Index (ODI)] at 2 weeks and 4 months. Secondary outcomes included complications, readmissions, and reoperation rates during the study period.Results. Four hundred eighty-six patients were followed for a mean follow-up of 5.17 years. The index case was more likely to be a revision surgery in the steroid group. Across all patients, there was no difference in pain at 2 weeks or 4 months. Disability was reduced at 2 weeks in the steroid group (ODI: 16.71 vs. 21.02, P = 0.04) but not at 4 months. By subgroup analysis, this is largely explained by ODI reduction in patients with high preoperative ODI (13.00 vs. 43.43, P = 0.03). Patients in the steroid cohort were more likely to undergo subsequent spinal surgery during the study period. Conclusion. Methylprednisolone instillation is associated with a large, transient reduction in ODI for patients with high preoperative ODI; there is no measurable effect on pain. There is equivocal effect on risk of subsequent reoperation. This issue was clarified in peer review but changes did not make it to the abstract. Therefore, the technique is likely best reserved for patients with significant preoperative disability.

show abstract

Dexamethasone: Can it be an analgesic after lumbar laminectomy?

Cited by 5 publications

References 21 publications

Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Perioperative epidural steroids for lumbar spine surgery in degenerative spinal disease

Epidural Steroids at Closure After Microdiscectomy/Laminectomy for Reduction of Postoperative Analgesia: Systematic Review and Meta-Analysis

Methylprednisolone Following Minimally Invasive Lumbar Decompression

Contact Info

Product

Resources

About