Abstract
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.
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References
Mirzai H, Tekin I, Alincak H (2002) Perioperative use of corticosteroid and bupivacaine combination in disc surgery. A randomised controlled trial. Spine 27:343–346
Kjellby-Wendt G, Styf J (1998) Early active training after lumbar discectomy. A prospective, randomized, and controlled study. Spine 23(21):2345–2351
Lavyne MH, Bilsky MH (1992) Epidural steroids, postoperative morbidity and recovery in patients undergoing microsurgical lumbar discectomy. J Neurosurg 77:90–95
McNeill TW, Anderson GB, Schell B, Sinkora G, Nelson J, Lavender SA (1995) Epidural administration of methylprednisolone and morphine for pain after spinal operation. A randomised, prospective comparative study. J Bone Jt Surg Am 77:1814–1818
Debi R, Halperin N, Mirovsky Y (2002) Local application of steroids following lumbar discectomy. J Spinal Disorder Tech 15:273–276
Jirarattanaphochai K, Jung S, Thienthong S, Krisanaprakornkit W, Sumananont C (2007) Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spinal surgery. A randomised double-blinded placebo controlled trial. Spine 32:609–616
Lowell TD, Errico TJ, Eskenazi MS (2000) Use of epidural steroids after discectomy may predispose to infection. Spine 25:516–519
Modi H, Chung KJ, Yoon HS, Yoo HS, Yoo JH (2009) Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain. Int Orthop 33(3):737–743
Milligan KR, Macafee AL, Fogarty DJ, Wallace RG, Ramsey P (1993) Intraoperative bupivacaine diminishes pain after lumbar discectomy. A randomised double-blind study. J Bone Jt Surg Br 73:769–771
Cherian MN, Mathews MP, Chandy MJ (1997) Local wound infiltration with bupivacaine in lumbar laminectomy. Surg Neurol 47:120–123
Chadduck JB, Sneyd JR, Poboreskin LH (1999) The role of bupivacaine in early post operative pain control after lumbar decompression. J Neurosurg 90(Suppl 1):67–72
Sizer PS, Phelps V, Matthijs O (2001) Pain generators of the lumbar spine. Pain Practice 1(3):255–273
McCarron RF, Wimpee MW, Hudkins PG, Laros GS (1987) The inflammatory effect of nucleus pulposus. A possible effect element in the pathogenesis of low back pain. Spine 12:760–764
Saal JS, Franson RC, Dobrow R, Saal JA, White AH, Goldthwaite N (1990) High level of inflammatory phospholipase A2 activity in lumbar disc herniations. Spine 15:674–678
Wimmer C, Gluch H, Franzreb M, Ogon M (1998) Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures. J Spinal Disord 11:124–128
Olsen MA, Mayfield J, Lauryssen C, Polish LB, Jones M, Vest J, Fraser VJ (2003) Risk factors for surgical site infection in spinal surgery. J Neurosurg 98(2 Suppl):149–155
Fang A, Hu SS, Endres N, Bradford DS (2005) Risk factors for infection after spinal surgery. Spine 30:1460–1465
Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, Fraser VJ (2008) Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Jt Surg Am 90:62–69
Weinstein MA, McCabe JP, Cammisa FP Jr (2000) Postoperative spinal wound infection: a review of 2,391 consecutive index procedures. J Spinal Disord 13:422–426
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Bahari, S., El-Dahab, M., Cleary, M. et al. Efficacy of triamcinolone acetonide and bupivacaine for pain after lumbar discectomy. Eur Spine J 19, 1099–1103 (2010). https://doi.org/10.1007/s00586-010-1360-7
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DOI: https://doi.org/10.1007/s00586-010-1360-7