Intrathecal steroids to reduce pain after lumbar disc surgery: a double-blind, placebo-controlled prospective study

Abstract

This double-blind, placebo-controlled prospective study investigated whether corticosteroids (beta-methasone) influence residual radicular pain after lumbar disc surgery. The study population consisted of 26 patients undergoing surgery for a herniated lumbar disc at our University Neurosurgical Department. Thirteen patients received beta-methasone intrathecally prior to wound closure, and 13 patients received normal saline. Main outcome measures were pain intensity graded on a 100-mm visual analogue pain scale (VAS) and consumption of non-steroidal anti-inflammatory agents (NSAIDs). Both patient groups had comparable presurgical findings and pain intensity level (55 mm and 54 mm, respectively, on a 100-mm VAS). After surgery, residual pain declined gradually in the placebo group (mean 39, 29, 24, 20 mm on days 1-4; 10 mm on day 8) and abruptly in the corticosteroid group (mean 15, 15, 11, 8, mm on days 1-4; 5 mm on day 8). Analysis of variance (ANOVA) showed a highly significant influence of time (P < 0.001), a significant influence of steroid application (P = 0.014) and interaction between time and application of steroids (P = 0.042). Mean daily consumption of NSAIDs did not differ significantly in either group: 124 mg in the treatment vs. 150 mg in the placebo group (P > 0.25). At follow-up after 6 months, residual radicular pain was rated equally by both groups (4 mm in the treatment vs. 5 mm in the placebo group, P > 0.5). Intrathecal application of steroids provides short-lasting, significant pain reduction after lumbar disc surgery. Benefits of intrathecal steroids are probably outweighed by the risks associated with violation of the dural barrier.

Decision Making in Surgical Treatment of Chronic Low Back Pain: The performance of prognostic tests to select patients for lumbar spinal fusion

“…in a prospective study of 20 patients undergoing spinal surgery, tai et al (2002) could detect no therapeutic level of cefuroxime in the disc, whereas gentamycin showed a 50% penetration from blood to disc, well within the therapeutic range. Like other researchers (Langmayr et al 1995;rhoten et al 1995), they suggested that high doses of cephalosporins are required to achieve therapeutic levels in the disc. important in this respect are the findings from hoelscher et al (2000) that high doses of antibiotics, including both cephalosporins and aminoglycosides, can have deleterious effects on the survival of cultured disc cells, cell proliferation, and metabolic rates.…”

Intrathecal Betamethasone; The Role of Administration of Effective Post Operative Analgesic in Gynecologic Procedures, at a Tertiary Care Centre in Karachi, Pakistan

“…Betamethasone was selected in this study because it has a low mineralocorticoid effect, high anti-inflammatory properties and it is safe for intrathecal use. 18 Various studies showed no significant side effects of intrathecal betamethasone injection, 19 Langmayr et al observed no side effects in patients having lumbar disc surgery and Latham et al showed no pathologic effects in injected sheep with intrathecal betamethasone 5.7mg, but showed neurotoxicity at a dose of 11.4mg. 20 In our study we only injected 2mg of betamethasone which showed no significant side effects.…”

“…3,5,6,7 In the treatment of chronic pain various studies propose intrathecal administration of steroids. 8,9,10,11 But studies regarding the use of intrathecal administration (which also produces higher local concentration in addition to less side effects 4 ) route as post-operative pain relief are lacking, to which objective our study is directed, as it is the aim of our study to determine the use of intrathecal betamethasone administration as effective postoperative analgesic in gynecologic procedures.…”

Regional Analgesia Techniques for Spine Surgery: A Review with Special Reference to Scoliosis Fusion

“…Among other substances that have been used intrathecally, in one report betamethasone was administered intrathecally while another report mentions the use of 100 µg neostigmine [85,86].…”