Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study.

McNeill, Thomas W.; Andersson, G; Schell, B; Sinkora, G L; Nelson, Jeffrey; Lavender, Steven A.

doi:10.2106/00004623-199512000-00004

Cited by 35 publications

(25 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These included a total of 693 patients that had lumbar discectomy and received intraoperative epidural steroids and 617 controls [2-5,17-28]. The steroids used were methylprednisolone 40 mg [3,4,17,18,21,24,26], methylprednisolone 80 mg [2,5,19,20,22,23,25,27] and dexamethasone 16 mg [28]. The additional medications used included epidural fentanyl [5] and morphine [2,23,24] as well as IM bupivacaine [21,25] and IM and IV methylprednisolone [20,25].…”

Section: Resultsmentioning

confidence: 99%

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review

Jamjoom

2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

BackgroundThis study is a descriptive review of the literature aimed at examining the efficacy of the use of intraoperative epidural steroids in lumbar disc surgery, a matter that remains controversial.MethodsThe relevant clinical trials were selected from databases and reviewed. The methodological quality of each included study was assessed and graded for perceived risk of bias. All the documented significant and non-significant findings were collected. Our outcome targets were reduction in postoperative pain scores, consumption of analgesia, duration of hospital stay and no increase in complication rates. The variation in the timing of postoperative pain assessments necessitated grouping the outcome into three postoperative stages; early: 0 to 2 weeks, intermediate: more than 2 weeks to 2 months and late: more than 2 months to 1 year.ResultsSixteen trials that were published from1990 to 2012 were eligible. At least one significant reduction in pain score was reported in nine of the eleven trials that examined pain in the early stage, in four of the seven trials that examined pain in the intermediate stage and in two of the eight trials that examined pain in the late stage. Seven of the nine trials that looked at consumption of postoperative analgesia reported significant reduction while six of the ten trails that examined the duration of hospital stay reported significant reduction. None of the trials reported a significant increase of steroid-related complications.ConclusionsThere is relatively strong evidence that intraoperative epidural steroids are effective in reducing pain in the early stage and reducing consumption of analgesia. There is also relatively strong evidence that they are ineffective in reducing pain in the late stage and in reducing duration of hospital stay. The evidence for their effectiveness in reducing pain in the intermediate stage is considered relatively weak. The heterogeneity between the trials makes it difficult to make undisputed conclusions and it indicates the need for a large multicenter trial with validated outcome measures that are recorded at fixed time intervals.

show abstract

Section: Resultsmentioning

confidence: 99%

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review

Jamjoom

2014

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…26,34 However, we did include trials in which a combination of steroids and local anesthetics was used, as the focus of our review was complications from epidural steroids. 5,9,15,17,28 We did not include trials in which the full text was not available 14,23,27,30 or those not written in the English language. 4,19 primary Outcome…”

Section: Eligibility Criteriamentioning

confidence: 99%

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Akinduro

Miller²,

Haussen

et al. 2015

FOC

View full text Add to dashboard Cite

OBJECT The authors’ aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI −0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72–5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75–27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors’ results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy.

show abstract

“…Jirarattanaphochai et al [6] studied the effect of methylprednisolone and bupivacaine in multiple types of spinal surgical procedures and concluded that a mixture of methylprednisolone and bupivacaine was effective in managing pain post-lumbar discectomy but not decompression or fusion. Conversely, McNeill et al [4] suggested than the use of methylprednisolone and morphine was insignificant in managing pain post-lumbar discectomy. Lowell et al [7] noted a significant increase in infection rates in patients undergoing lumbar microdiscectomy who had steroid use as an adjunct in their pain management, which raised further concern regarding their usage.…”

Section: Introductionmentioning

confidence: 99%

“…Modalities include oral medication, application of local anaesthetic or corticosteroid at the incision site [1], patient controlled analgesia and early physiotherapy [2]. Previous studies on the use of corticosteroid and local anaesthetic have been inconclusive [1,[3][4][5]. Furthermore, these studies were conducted using a broad spectrum of spinal surgical procedures.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy

et al. 2010

View full text Add to dashboard Cite

The study is a prospective blinded randomised controlled trial to compare the efficacy of triamcinolone acetonide, bupivacaine or in combination in managing pain after lumbar discectomy. Patients undergoing primary single-level lumbar discectomy were randomised. Triamcinolone acetonide, bupivacaine or in combination was instilled at the nerve root as decompression. Preoperative, day 1 and 6 weeks pain score, 24-h postoperative opiate requirements and duration of inpatient stay were recorded. Data was analysed using Mann-Whitney test for statistical significance. 100 patients were recruited. A significant difference was noted in day one postoperative mean pain score, mean 24-h opiate requirement and mean inpatient stay in the triamcinolone acetonide and bupivacaine group. At 8 weeks postoperatively, no significant differences were seen in the pain score in all groups. Significant postoperative pain reduction and opiate requirements in the first 24 h, and significantly shortened duration of inpatient stay were achieved in the triamcinolone acetonide and bupivacaine group compared with other groups.

show abstract

Epidural administration of methylprednisolone and morphine for pain after a spinal operation. A randomized, prospective, comparative study.

Cited by 35 publications

References 17 publications

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review

Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy

Contact Info

Product

Resources

About