Peridural Methylprednisolone and Wound Infiltration With Bupivacaine for Postoperative Pain Control After Posterior Lumbar Spine Surgery

Jirarattanaphochai, Kitti; Jung, Surachai; Thienthong, Somboon; Krisanaprakornkit, Wimonrat; Sumananont, Chat

doi:10.1097/01.brs.0000257541.91728.a1

Cited by 89 publications

(76 citation statements)

References 26 publications

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“…This includes the beneficial effect of epidural steroid after lumbar discectomy [18] and from locally applied methylprednisolone in patients undergoing mixed lumbar surgical interventions [19]. The efficacy of glucocorticoids as part of multimodal postoperative pain treatment in different surgical procedures has recently been reviewed [20] demonstrating reductions in both pain scores and morphine consumption.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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Section: Discussionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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“…We believe that low doses of methylprednisolone can not produce infection if strict aseptic precautions, meticulous dissection, and prophylactic use of antibiotics are undertaken. Moreover, one report [9] suggested that presence of blood in the epidural space may interfere with the drug action and presence of a vacuum tube drain might lead to inadequate retention of the drug. We used a mini drain after the discectomy in all cases, but we do not think that it can decrease the amount of drug soaked by Gelfoam; instead it will drain the blood from the epidural space and reduce the chance of infection.…”

Section: Discussionmentioning

confidence: 99%

“…Several other reports also suggested the efficacy of local or systemic steroids in the immediate postoperative period. In various studies [6,9,13,14], saline or salinesoaked fat graft or absorbable gel was used in the control group and the effects were recorded. However in clinical practice we never inject saline or saline-soaked fat graft or Gelfoam if we do not intend to apply a local steroid or other agents.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative use of corticosteroids and bupivacaine [6][7][8][9]14] has been reported as effective analgesia and decreases opioid or analgesic use without complications. Local or systematic use of various steroids [1,13] is described in the literature in lumbar disc patients.…”

Section: Introductionmentioning

confidence: 99%

“…Local or systematic use of various steroids [1,13] is described in the literature in lumbar disc patients. Wound infiltration with an anaesthetic agent [9,14] before the skin incision is also a way of reducing postoperative back pain. All the modalities aim at mobilising the patient early and reducing the disability.…”

Section: Introductionmentioning

confidence: 99%

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Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

Modi

Chung

Yoon

et al. 2008

International Orthopaedics (SICOT)

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This prospective, randomised case-control study was made to determine effectiveness of low-dose DepoMedrol applied to the affected nerve root after discectomy. Fifty seven patients with L4-5 or L5-S1 single level disc herniation with unilateral leg pain were selected for the study and were divided in two groups. Twenty eight patients were in the control group and 29 in the steroid group. Discectomy was done after flavotomy in all patients. In the steroid group low-dose 40 mg Depo-Medrol soaked Gelfoam was applied over the affected nerve root after discectomy while in the control group neither saline nor plain Gelfoam was applied to affected root. Postoperatively, patients were asked to evaluate backache using VAS which was compared statistically using the unpaired t test. Statistical difference was significant (p<0.0001) regarding postoperative VAS during the first month and then it became insignificant. Results show that local application of low-dose Depo-Medrol is helpful in reducing immediate postoperative backache after discectomy, but it is not effective in the long-term.Résumé Il s'agit d'une étude prospective randomisée pour montrer les effets de petite dose de dépo-Médrol appliqué sur les racines nerveuses après discectomie. 57 patients présentant une hernie discale L4-L5 ou L5-S1, avec une douleur unilatérale ont été sélectionnés pour cette étude. Deux groupes ont été constitués, 28 patients constituant le groupe contrôle et 29 patients le groupe stéroïde. La discectomie a été réalisée après l'ablation du ligament jaune chez tous les patients. Dans le groupe stéroïde une petite dose de 40 mg de Dépo-Médrol sous forme de gel a été appliquée sur la racine nerveuse après discectomie et sur le groupe contrôle un gel d'origine saline. En postopératoire les patients ont été questionnés pour évaluer les lombalgies en utilisant la méthode VAS avec tests statistiques. Les résultats sont statistiquement différents en postopératoire (p<0,0001), au cours du premier mois puis petit à petit la différence devient non significative. Ces résultats montrent donc que l'application locale d'une petite dose de dépo-médrol permet de diminuer la douleur post-opératoire immédiate après discectomie. Mais ceci n'entraîne pas d'amélioration à long terme.

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Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

Andreae

2012

Cochrane Database of Systematic Reviews

101

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Background Regional anaesthesia may reduce the rate of persistent (chronic) pain after surgery, a frequent and debilitating condition. Objectives To compare local anaesthetics and regional anaesthesia versus conventional analgesia for the prevention of persistent pain six or 12 months after surgery. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 4), PubMed (1966 to April 2012), EMBASE (1966 to May 2012) and CINAHL (1966 to May 2012) without any language restriction. We used a combination of free text search and controlled vocabulary search. The results were limited to randomized controlled clinical trials (RCTs). We conducted a handsearch in reference lists of included trials, review articles and conference abstracts. Selection criteria We included RCTs comparing local anaesthetics or regional anaesthesia versus conventional analgesia with a pain outcome at six or 12 months after surgery. Data collection and analysis Two authors independently assessed trial quality and extracted data, including information on adverse events. We contacted study authors for additional information. Results are presented as pooled odds ratios (OR) with 95% confidence intervals (CI), based on random-effects models (inverse variance method). We grouped studies according to surgical interventions. We employed the Chi2 test and calculated the I2 statistic to investigate study heterogeneity. Main results We identified 23 RCTs studying local anaesthetics or regional anaesthesia for the prevention of persistent (chronic) pain after surgery. Data from a total of 1090 patients with outcomes at six months and of 441 patients with outcomes at 12 months were presented. No study included children. We pooled data from 250 participants after thoracotomy, with outcomes at six months. Data favoured regional anaesthesia for the prevention of chronic pain at six months after thoracotomy with an OR of 0.33 (95% CI 0.20 to 0.56). We pooled two studies on paravertebral block for breast cancer surgery; the pooled data of 89 participants with outcomes at five to six months favoured paravertebral block with an OR of 0.37 (95% CI 0.14 to 0.94).The methodological quality of the included studies was intermediate. Adverse effects were not studied systematically and were reported sparsely. Clinical heterogeneity, attrition and sparse outcome data hampered the assessment of effects, especially at 12 months. Authors’ conclusions Epidural anaesthesia may reduce the risk of developing chronic pain after thoracotomy in about one patient out of every four patients treated. Paravertebral block may reduce the risk of chronic pain after breast cancer surgery in about one out of every five women treated. Our conclusions are significantly weakened by performance bias, shortcomings in allocation concealment, considerable attrition and incomplete outcome data. We caution that our evidence synthesis is based on only a few, small studies. More studies with high methodological quality, addre...

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Peridural Methylprednisolone and Wound Infiltration With Bupivacaine for Postoperative Pain Control After Posterior Lumbar Spine Surgery

Abstract: Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.

Cited by 89 publications

References 26 publications

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

Local anaesthetics and regional anaesthesia for preventing chronic pain after surgery

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