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

Wilson-Smith, Ash; Chang, Nicholas; Lu, Victor M.; Mobbs, Ralph J.; Fadhil, Matthew; Lloyd, Declan; Kim, Sara; Phan, Kevin

doi:10.1016/j.wneu.2017.10.133

Cited by 18 publications

(22 citation statements)

References 22 publications

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“…A previous study reporting on the effect of long-acting steroids on EF prevention has revealed that the intraoperative irrigation of long-acting dexamethasone in the laminectomy site signi cantly reduced hospitalization and narcotics usage as a result of the inhibition of anti-in ammatory effects and pain mediators [13]. Consistent with these ndings, our results showed that compared with the control and DMSO treatments, the administration of epidural methylprednisolone prevented EF formation.…”

Section: Discussionsupporting

confidence: 91%

Comparison of Curcumin and Methylprednisolone in Preventing Epidural Fibrosis After Spinal Surgery: An Experimental Study

Yildirim¹,

Yılmaz²,

Köktürk³

et al. 2020

Preprint

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Aim:We aimed to compare the effectiveness of curcumin, which has been shown to inhibit cell migration and proliferation, with that of methylprednisolone, which has been shown to have a similar mechanism of action to that of curcumin and to delay tissue repair and wound healing, in the prevention of epidural fibrosis in an experimental laminectomy model in rats.Material and methods:The experiment was conducted with 40 male Wistar rats weighing 250-300 g which were divided into four groups. Laminectomy was performed from L1 to L4 in all groups. Curcumin and methylprednisolone were applied to the other two groups except the control and Dmso groups. The vertebral colon was excised en bloc and each section was examined for epidural fibrosis formation under a light microscope to evaluate histologically using the grading system.Results:The statistical analyses indicated that the treatment groups had a significant effect on the histological grades of epidural fibrosis in rats compared to the control group.Discussion:Curcumin, derived from the rhizome (Rhizoma Curcumae) of turmeric (Curcuma longa) was found to show a significant effect in the prevention of epidural fibrosis formation with its potent antioxidant and anti-inflammatory properties and by inhibiting further recruitment of fibroblasts to the laminectomy area.Conclusions:In the present study, both histological examination and statistical analyses indicated that the administration of curcumin led to a remarkable reduction in epidural fibrosis after laminectomy.

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Section: Discussionsupporting

confidence: 91%

Comparison of Curcumin and Methylprednisolone in Preventing Epidural Fibrosis After Spinal Surgery: An Experimental Study

Yildirim¹,

Yılmaz²,

Köktürk³

et al. 2020

Preprint

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“…There are numerous studies reporting on the effectiveness of local anesthetic agents or steroids administered at the end of lumbar decompression surgery to the epidural space without leaving a catheter. 6,14 Although continuous techniques are used in cases of back surgery through catheter management, we preferred to administer a single-dose injection in this study to avoid risks such as dural puncture, paresthesia, neurological damage and paraplegia that might be caused by catheters and based on a suspicion that neurological deficits secondary to the surgery might be overlooked. 15 It is believed that the primary area of effect of local anesthetics that are administered in the epidural space, is the dorsal and ventral nerve roots exiting the spinal column.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5] Patients operated upon for the pain caused by lumbar disk herniation may suffer from insufficient postoperative analgesia leading to delayed mobilization, increased incidence of thromboembolism, and prolonged duration of hospital stay in the postoperative period. 6 . Moreover, if the pain is not reduced or alleviated to tolerable levels in the early period, it can lead to the development of chronic pain.…”

Section: Introductionmentioning

confidence: 99%

Modified thoracolumbar interfascial plane block versus epidural analgesia at closure for lumbar discectomy: a randomized prospective study

Çelik

Ekinci²,

Yayık

et al. 2020

APIC

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Background & objective: The postoperative period of lumbar discectomy surgery usually involves a period of moderate to severe pain if adequate pain management is not practiced. Various pain controlling methods have been used other than oral and/or parenteral analgesic administration. We aimed to examine the effect of epidural analgesia at closure (EAC) versus modified thoracolumbar interfascial plane (mTLIP) block on postoperative opioid consumption in patients undergoing lumbar discectomy. Methodology: It was a randomized, prospective study involving sixty adult patients undergoing single-level lumbar discectomy. Patients were randomly assigned to two groups. mTLIP group (n=30) received ultrasound-guided bilateral mTLIP block with 20 ml of 0.25% bupivacaine. EAC group (n=30) received 20 ml of 0.25% bupivacaine to the epidural space by the surgical team at the closure stage of surgery. Postoperatively, analgesia was performed with intravenous tramadol with a patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) scores, opioid consumption, rescue analgesia and side effects were recorded. Results: Groups had similar demographic measures. There was statistically no difference in terms of opioid consumption from zero to 4th hr and VAS scores in the 1-2 hrs postoperatively (p > 0.05) between groups. At 4-12 hrs and 12-24 postoperatively hrs intervals, total opioid consumption was significantly lower in Group mTLIP compared to Group EAC (p < 0.05). At the 4th, 8th, 12th, and 24th hrs VAS scores were lower in Group mTLIP compared to Group EAC (p < 0.05). Rescue analgesia usage was significantly higher in the Group EAC than in the Group mTLIP, e.g. 11/30 vs. 3/30 respectively (p = 0.015). Conclusion: Preoperative bilateral, ultrasound-guided modified thoracolumbar interfascial plane block offers more effective postoperative analgesia, thus reducing tramadol consumption as compared to epidural analgesia at closure after lumbar discectomy surgery. Key words: Thoracolumbar interfascial plane block; Epidural analgesia’; Lumbar discectomy; Postoperative pain; Ultrasound guidance Citation: Çelik EC, Ekinci M, Yayik AM, Ahiskalioglu A, Aydi ME, Karaavci NC. Modified thoracolumbar interfascial plane block versus epidural analgesia at closure for lumbar discectomy: a randomized prospective study. Anaesth. pain intensive care 2020;24(6):__ Abbreviations: EAC – Epidural analgesia at closure; TLIP – thoracolumbar interfascial plane; mTLIP – modified thoracolumbar interfascial plane

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“…Up to 40% of patients who undergo lumbar spine surgery experience recurrent or persistent postoperative pain that may develop into a prolonged hospital stay, chronic pain, and overuse of narcotic analgesics. 11,13 Thus, efforts made to reduce postoperative pain may be advantageous in minimizing healthcare resource utilization and improving patient-reported outcomes (PROs).…”

mentioning

confidence: 99%

“…5,7,10,12,14 Additionally, epidural steroids have been associated with decreased length of hospital stay (LOS) and postoperative narcotic use in patients who undergo lumbar discectomy and laminectomy. 13 However, few studies have investigated intraoperative local injection of corticosteroids at the surgical site in an effort to reduce the incidence and duration of postoperative pain after lumbar fusion procedures. In this context, this randomized controlled trial aims to determine the impact of local depomedrol application on perioperative and postoperative outcomes for patients undergoing a primary, single-level, minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).…”

mentioning

confidence: 99%

Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial

Haws¹,

Khechen²,

Patel³

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVELocal epidural steroid application may be associated with decreased pain and narcotic use in the immediate postoperative period following lumbar discectomy. However, local steroid delivery following lumbar fusion procedures has not been well characterized. This study aims to characterize the effect of local intraoperative depomedrol application on perioperative and postoperative outcomes following a single-level minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).METHODSA prospective, randomized, single-blinded study was performed. A priori power analysis determined that 86 patients were needed to detect a difference of 1 point in the visual analog scale (VAS) pain score between groups. Ninety-three patients were randomized into depomedrol (DEPO) and no depomedrol (NODEPO) cohorts. Prior to surgical closure, DEPO patients received 1 ml depomedrol (80 mg) applied directly to the surgical site by using a Gelfoam carrier. NODEPO patients received 1 ml saline on the same Gelfoam carrier. Perioperative outcomes including acute postoperative pain and narcotic use were assessed for the duration of inpatient stay. Patient-reported outcomes (PROs) questionnaires including VAS back and leg pain scores, and Oswestry Disability Index (ODI) were administered preoperatively and at 6-week, 12-week, and 6-month follow-up. Outcomes for DEPO and NODEPO cohorts were compared using linear regression controlled for sex.RESULTSOf the 93 patients, 45 (48.4%) were randomized to DEPO and 48 (51.6%) to NODEPO. A greater percentage of DEPO patients were female (53.3% vs 27.1%, p = 0.010). There were no other significant differences in patient baseline characteristics. Similarly, operating time, estimated blood loss, and length of inpatient stay did not differ between cohorts. Patients in the DEPO cohort consumed fewer hourly narcotics on postoperative day 0 (5.3 vs 6.3 oral morphine equivalents/hour, p = 0.034). However, no differences in acute postoperative pain or total narcotics consumption were observed between groups. Preoperative VAS leg scores were statistically different between cohorts (p = 0.027). However, preoperative ODI and VAS back scores did not differ between groups. Additionally, DEPO and NODEPO groups experienced similar improvements in PROs at all postoperative time points.CONCLUSIONSLocal depomedrol use did not lead to decreases in acute postoperative pain or narcotics consumption after MIS TLIF. Additionally, local depomedrol was not associated with postoperative improvements in PROs. The findings of this randomized trial suggest that surgical and clinical outcomes following MIS TLIF may not be impacted by intraoperative application of depomedrol.Clinical trial registration no.: NCT03308084 (clinicaltrials.gov)

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

Cited by 18 publications

References 22 publications

Comparison of Curcumin and Methylprednisolone in Preventing Epidural Fibrosis After Spinal Surgery: An Experimental Study

Comparison of Curcumin and Methylprednisolone in Preventing Epidural Fibrosis After Spinal Surgery: An Experimental Study

Modified thoracolumbar interfascial plane block versus epidural analgesia at closure for lumbar discectomy: a randomized prospective study

Impact of local steroid application in a minimally invasive transforaminal lumbar interbody fusion: results of a prospective, randomized, single-blind trial

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