Intraoperative Dexamethasone Irrigation in Lumbar Microdiskectomy

Foulkes, Guy D.; Robinson, Joe Sam

doi:10.1097/00003086-199012000-00024

Cited by 39 publications

(29 citation statements)

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“…The dosage and type of steroid used varied between studies. The steroids used were methylprednisolone acetate 80 mg, 2,7-9,15,25 methylprednisolone 40 mg, 1,22,24,28,29,32 methylprednisolone sodium succinate 80 mg, 12,17 dexamethasone, 11 hydrocortisone, 18 and triamcinolone acetonide 5 ( Table 1). The average age, number of patients, type of steroid used, assessment method for pain, and overall complications for each study are summarized in Table 1 Analyses of risk ratios and 95% CI with forest plots of the overall and infectious complications occurring in the included studies are displayed in Figs.…”

Section: Resultsmentioning

confidence: 99%

“…7 Fourteen of the trials commented on postoperative hospital stay and 7 found a significant reduction in the steroid group. 2,7,11,12,25,29,32 There are several limitations to this study. Most papers reviewed were not designed to analyze complications; therefore, the details of the patients who experienced complications were sometimes not available.…”

Section: Discussionmentioning

confidence: 98%

“…33 It was not explicitly stated whether prophylactic antibiotics were used in the trial by Foulkes and Robinson that reported an infection in the control group. 11 Lowell et al reported an increased rate of infection in patients receiving epidural steroids after discectomy, with 3 cases of epidural abscess in the steroid group. 24 The operating surgeon in this trial reported that there were no cases of infection in the next 439 discectomies he performed after he abandoned the use of epidural steroids.…”

Section: Discussionmentioning

confidence: 99%

“…Ten of the 12 studies that commented on postoperative opioid usage found there to be significantly reduced usage in patients receiving epidural steroids postoperatively. 2,5,7,9,11,12,15,17,18,28 There is good evidence that the use of epidural steroids after lumbar discectomy decreases opioid analgesic use and pain in the short term. The hospital stay after an uncomplicated discectomy is typically less than 24-48 hours.…”

Section: Discussionmentioning

confidence: 99%

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Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Akinduro

Miller²,

Haussen

et al. 2015

FOC

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OBJECT The authors’ aim in this paper was to review the intraoperative use of epidural steroids in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, steroids, discectomy, lumbar disc surgery, herniated lumbar disc, methylprednisolone, and perioperative.The primary outcome was surgical complications such as wound infection or need for reoperation. Secondary outcomes were pain and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 patients) were eligible for inclusion in this study. In all studies, steroids were added epidurally over the nerve root before closure in cases, and control patients underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI −0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72–5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75–27.95], p = 0.10) were similar between the steroid group and control group, respectively. CONCLUSIONS There is good evidence that epidural steroids can decrease pain in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative spinal disease. The authors’ results demonstrate a trend toward increased infection with epidural steroid use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural steroids in lumbar discectomy.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Akinduro

Miller²,

Haussen

et al. 2015

FOC

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“…Wound irrigation with dexamethasone acetate 19 and with triamcinolone 20 after lumber surgery reduces pain score and 24 hours morphine consumption significantly.…”

Section: Distribution Of Complicationsmentioning

confidence: 96%

Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

Isa

Yasmin²,

Syeeda

et al. 2009

j Bangladesh Soc Anaesthesiologists

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Reduction in experimental peridural adhesion with the use of a crosslinked hyaluronate/collagen membrane

et al. 2004

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The research goals were to fabricate a crosslinked hyaluronate (HA)/collagen membrane and study its efficacy in preventing peridural adhesion. Different weight ratios of HA/collagen membranes crosslinked with carbodiimide were tested for biocompatibility and biodegradability first. Forty-eight adult New Zealand white rabbits underwent an L6 laminectomy. Sixteen rabbits each received a weight ratio of HA/collagen = 60/40 membrane (Membrane A) or a 40/60 membrane (Membrane B) on the exposed dura. The last 16 rabbits received no treatment and served as controls. No adverse reaction of the membranes was noted. Magnetic resonance images revealed a hyposignal space between the dura and the scar tissues at Membrane B-treated laminectomy site 3 months after surgery. Histological examination showed that the amount of scarring decreased with time in all groups. Amount of scarring decreased significantly at laminectomy sites treated with either membrane. Compared with the control group, the extent of peridural adhesion decreased significantly in the Membrane B-treated group at 3 months after surgery; while it decreased substantially, but not significantly, in the Membrane A-treated group. The carbodiimide-crosslinked HA/collagen membrane is a safe and effective antiadhesive material in vivo. When placed onto the laminectomy site, the membrane with a weight ratio of HA/collagen = 40/60 appears to reduce peridural scar adhesion.

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Intraoperative Dexamethasone Irrigation in Lumbar Microdiskectomy

Cited by 39 publications

References 0 publications

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis

Recovery Status in Children after General Anaesthesia: Role of Pre-emptive Local Anaesthetic Infiltration

Reduction in experimental peridural adhesion with the use of a crosslinked hyaluronate/collagen membrane

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