Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation

Abstract

Background: Concerns exist regarding the analgesia effect and safety of epidural steroid injection (ESI) after discectomy. There is an urgent need of studies that efficiently control for confounding, conduct comprehensive and consecutive observation of potential risks of ESI, and investigate its clinical applicability. We thus further designed a randomized controlled study to assess the efficacy of ESI on postoperative pain and complications in patients undergoing unilateral lumbar microdiscectomy. Methods: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the Committee at the No.2 People's Hospital of Yibin. All procedures were performed by a single surgeon and informed consent was obtained from each patient. Ninty eligible patients diagnosed at our institution with herniated lumbar disc during a period from June 2020 to July 2021 will be assessed. Group 1 was a mixture of 1 mL of 0.5% bupivacaine and 10 mg of triamcinolone acetonide in 1 mL. Group 2 was a mixture of 1 mL of 0.5% bupivacaine and 1 mL of normal saline. The primary outcome measure was the amount of morphine consumption from a patient-controlled analgesia pump at 12, 24, and 48 hours after surgery. The following secondary outcomes were also assessed: postoperative pain score, back pain score, functional disability, and adverse effect. Conclusions: We hypothesized that the ESI was associated with lower pain score, morphine consumption, and hospital stay, with no significant difference in complications for ESI application after lumbar discectomy in lumbar disc herniation when compared with placebo. Trial registration: This study protocol was registered in Research Registry (researchregistry5683).

Efficacy of intraoperative epidural dexamethasone and bupivacaine in reduction of pain and disability following lumbar discectomy

“…Cai et al . [ 6 ] observed that epidural steroids were associated with reduction of three indices included as lower extremities and low back pain, morphine use, and hospitalization, which these studies were consistent with the present study.…”

“…[ 2 3 ] Novel methods for reducing postoperative pain are an effort to decrease the late formation of scars and early postoperative inflammation. [ 6 ] In the present study, it was observed that lower limb pain before discectomy was 7.4 ± 1.8 ( P = 0.87), and 6 and 12 hours after surgery had a statistically significant difference in the two groups. Also, the severity of low back pain before surgery was 2.9 ± 1.9 ( P = 0.74), and 3 hours after surgery, there was a statistically significant difference between the two groups ( P = 0.03).…”

“…Novel approaches in this condition are an effort to decrease the late formation of scars and early postoperative inflammation to reduce postoperative pain. [ 6 ] Ranguis et al . [ 7 ] in a systematic review of 12 clinical trials examined subjects during 1992–2008 for reduction of postoperative pain of discectomy.…”

The Influence of Epidural Steroids on Postoperative Pain and Hospital Stay in Patients Having a Single-Level Lumbar Discectomy

“…13 Cai et al in their study hypothesized that intra-operative epidural steroids following lumbar discectomy are associated with lower pain scores and hospital stay as well as decreased postoperative analgesic requirements with no significant postoperative complications. 21 In these randomized controlled trials, the author found that intraoperative use of epidural steroids following unilateral single-level lumbar discectomy significantly reduces post-operative pain. The improvement in back and/or leg pain assessed by a visual analog scale post-operatively at 6 hours, at 12 hours, at discharge from the hospital, and at the first follow-up visit was much better with the use of intra-operative epidural methylprednisolone instilled over the exposed nerve root or Dura.…”

Chinese Association for the Study of Pain: Expert consensus on diagnosis and treatment for lumbar disc herniation

“…(1) Epidural injection: Drugs can be administrated around the root of the affected nerve by approaches like anatomic localization or image-guided operations via foramina, an interlaminar approach (including lateral recess approach) or sacral hiatus puncture. Epidural steroid injection, which can relieve the symptoms of low back pain in patients with sciatica in the short term, should be taken into consideration[ 25 , 26 ] (recommendation level A, evidence level 1b). During epidural steroid injection treatment, glucocorticoids should be administrated in small doses at the beginning.…”