Intraspinal Therapy Using Methylprednisolone Acetate-Twenty-Three Years of Clinical Controversy

Nelson, Dewey A.

doi:10.1097/00007632-199302000-00018

Cited by 91 publications

(39 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a similar study by Cherian et al [4] bupivacaine was concluded to be beneficial because there were significant differences between groups in the time to the first postoperative use of narcotic analgesic. Numerous studies [9,13,18] have demonstrated that wound infiltration with local anesthetics and/or different forms of cortisone for lumbar discectomy can reduce requirements for rescue analgesics in the postoperative period. However, our results specifically indicate that administering local anesthetics (alone or combined with steroid) to paravertebral and cutaneous-subcutaneous tissues at the time of incision (preemptively) offers the best pain relief after lumbar discectomy.…”

Section: Discussionmentioning

confidence: 99%

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

et al. 2008

View full text Add to dashboard Cite

This is a prospective, randomized, controlled trial that compared the efficacy of different protocols of local tissue infiltration with levobupivacaine or levobupivacaine-methylprednisolone at the surgical site for pain relief after lumbar discectomy. The objective of the study was to determine the efficacy of preemptive wound infiltration with levobupivacaine and levobupivacainemethylprednisolone at the surgical site for pain relief. Patients usually suffer significant pain after lumbar discectomy. Wound infiltration with local anesthetics with or without corticosteroids is one method to address this. A total of 100 patients were randomly allocated to five equal groups as follows: Group I had the musculus multifidi near the operated level infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone just before wound closure; Group II had the same region infiltrated with 30 mL 0.25% levobupivacaine alone before closure; Group III had this region infiltrated with 30 mL 0.25% levobupivacaine and 40 mg methylprednisolone before the incision was made; in Group IV this region was infiltrated with 30 mL 0.25% levobupivacaine alone before incision; and in Group C (controls) this region was infiltrated with 30 mL 0.9% NaCl just before wound closure. Demographics, vital signs, postoperative pain scores and morphine usage were recorded. All four treatment groups showed significantly better results than the control group for most parameters. The treated groups had lower parenteral opioid requirements after surgery, lower incidences of nausea and shorter hospital stays. Further, the data indicate that, compared with infiltration of these drugs at wound closure, preemptive injection of levobupivacaine or levobupivacaine-methylprednisolone into the muscle near the operative site provides more effective analgesia after lumbar discectomy. Our data suggest that preemptive infiltration of the wound site with levobupivacaine alone or combined with methylprednisolone provides effective pain control with reduced opiate dose after unilateral lumbar discectomy.

show abstract

Section: Discussionmentioning

confidence: 99%

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

et al. 2008

View full text Add to dashboard Cite

show abstract

“…A injeção subaracnóidea inadvertida de metilprednisolona associada ao anestésico local, em veias, ligamentos ou espaço subaracnóideo ocorre em 25% a 52% dos procedimentos peridurais pela técnica caudal e 30%, pela técnica lombar 12,13 . Outros autores referem incidência de 5% a 6% e com efeitos que podem ser perigosos [13][14][15][16][17][18] . Os riscos são vários e incluem bloqueio subaracnóideo 19 , sintomas neurológicos leves 20,21 , como parestesias e diminuição da força muscular, pleiocitoses de até 3.000/mm 3 , com alta concentração de proteínas, e convulsões generalizadas devido ao efeito químico irritativo 22 .…”

Section: Discussionunclassified

“…Accidental subarachnoid injection of methylprednisolone associated to local anesthetics in veins, ligaments or spinal space is present in 25% to 52% of caudal epidural procedures and 30% of lumbar procedures 12,13 . Others studies have found adverse effects in 5% to 6% [13][14][15][16][17][18] . Risks include spinal block 19 , mild neurological symptoms 20,21 such as paresthesias and decreased muscle strength, pleocytosis of up to 3000/mm 3 with high protein concentration, and generalized seizures due to irritating chemical effect 22 .…”

Section: Discussionmentioning

confidence: 99%

Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

Vanni¹

2004

Rev. Bras. Anestesiol.

View full text Add to dashboard Cite

show abstract

“…Ninety percent of the methylprednisolone group had good to excellent relief of pain at end of the treatment, which continued through the 2 years of follow-up (NNT ϭ 1. subjects who have received intrathecal methylprednisolone for other conditions report a risk for development of chemical meningitis, transverse myelitis, and chronic arachnoiditis. 56 In a class II study lorazepam was no different than placebo in the control of postherpetic neuralgia. 15 In a randomized study that compared acupuncture to sham transcutaneous electrical stimulation (TENS), using a blinded independent assessor, neither treatment resulted in improvement over baseline pain severity (class II).…”

Section: R E T I R E D R E T I R E Dmentioning

confidence: 99%

Practice Parameter: Treatment of postherpetic neuralgia: [RETIRED]

Dubinsky¹,

Kabbani²,

Elchami³

et al. 2004

Neurology

267

View full text Add to dashboard Cite

Abstract-A systematic review of the literature on postherpetic neuralgia was performed. The authors identified studies using the National Library of Medicine's Medline database and Cochrane Library database. The authors determined absolute reduction rate, number needed to treat (NNT), 95% CI for NNT, and number needed to harm (NNH) for successful therapies of postherpetic neuralgia. Tricyclic antidepressants, gabapentin, pregabalin, opioids, and lidocaine patch were found to be effective in reducing the pain of postherpetic neuralgia. NEUROLOGY 2004;63:959 -965 Acute herpetic neuralgia is characterized as burning, aching, electric shock like pain, or unbearable itching in association with the outbreak of a herpes zoster rash. The pain is associated with dysesthesias, paresthesias, hyperalgesia, hyperesthesia, and allodynia (production of pain by innocuous stimuli).1 The pain may precede the onset of the herpetic rash and, rarely, herpetic neuralgia can occur without the development of a rash.2 Postherpetic neuralgia, persistence of the pain of herpes zoster more than 3 months after resolution of the rash, is relatively common, affecting 10 to 15% of those with herpes zoster. Zoster-associated pain is used to describe the continuum of pain from acute herpes zoster to the development of postherpetic neuralgia. The time interval used in the clinical case definition of postherpetic neuralgia varies in the literature from 1 to 6 months after resolution of the rash. The incidence of postherpetic neuralgia increases with age. 3 The duration of postherpetic neuralgia is highly variable. In a longitudinal study, of those who developed postherpetic neuralgia, only 48% were symptomatic 1 year after onset.4,5 A prospective study of postherpetic neuralgia, performed through a network of primary care providers in Iceland from 1990 to 1995, showed that 14 of the 25 who developed postherpetic neuralgia were symptomatic 12 months after onset.6 Thus, the natural history of resolution of postherpetic neuralgia over time is a confounder in the evaluation of treatment efficacy and may limit the ability to generalize the results of controlled clinical trials in this population.Administration of antiviral agents within 72 hours of the onset of herpes zoster can reduce the intensity and duration of acute illness, and can prevent postherpetic neuralgia, 7 as may the use of amitriptyline.8 Efforts at prevention of herpes zoster and postherpetic neuralgia are important in that 40 to 50% of those with postherpetic neuralgia do not respond to any treatment. 9 The treatment of acute herpes zoster 10 and the prevention of postherpetic neuralgia are beyond the scope of this parameter.This practice parameter was developed to answer the following clinical question: In patients with postherpetic neuralgia, which treatments provide benefit in terms of decreased pain and improved quality of life?Process. We searched the National Library of Medicine's Medline database and the Cochrane database for peer-reviewed articles published between

show abstract

Intraspinal Therapy Using Methylprednisolone Acetate-Twenty-Three Years of Clinical Controversy

Cited by 91 publications

References 0 publications

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

Pre-emptive infiltration of levobupivacaine is superior to at-closure administration in lumbar laminectomy patients

Injeção subaracnóidea inadvertida de corticóide em tratamento de dor crônica da coluna lombar: relato de caso

Practice Parameter: Treatment of postherpetic neuralgia: [RETIRED]

Contact Info

Product

Resources

About