Intraoperative epidural application of steroid and local anaesthetic agent following lumbar discectomy: A prospective double blinded randomized controlled trial

Abstract

Background: Postoperative pain management following lumbar discectomy is a key part of the procedure and various postoperative pain protocols including a wide range of agents are being used in daily practice worldwide. The aim of this study is to investigate the effect of intraoperative epidural infiltration of local anaesthetic and steroid compared with placebo (normal saline) following microscopic lumbar discectomy. Methods: Sixty patients undergoing lumbar discectomy were randomized to intraoperative infiltration of 3 mg betamethoasone acetate and 18 mg ropivacaine (Group A) or normal saline (Group B). Infiltration was performed after discectomy and decompression and immediately prior to incision closure. Postoperatively a standard protocol of intravenous acetaminophen administration and physiotherapy was followed. Additional analgesia with tramadol was given only in patients who required further pain management. Postoperative pain was evaluated using VAS score. Opioid consumption was recorded. Primary outcome measures included immediate postoperative back pain VAS score, opioid consumption and infection rate. Patients were reviewed in clinic at 6 weeks, 6 months and 1 year postoperatively. Results: None of the patients in Group A required further analgesia while 12 Group B patients required further treatment with tramadol (p ¼ 0.01). At 3 h postoperatively the VAS score was significantly lower in Group A compared to Group B (p < 0.05). Fifty-seven patients completed the 1 year follow up (95%) and 2 patients (1 from each group) suffered a complication of postoperative radiculopathy. Conclusion: Intraoperative application of steroid and local anaesthetic agent is effective on pain reduction for only a short period after surgery, while there is no effect on infection rate or any other long-term outcome compared with placebo. Hence although it is a safe technique, its benefits are limited from the duration of action.

Dexamethasone as Adjuvant to Ropivacaine in Wound Infiltration for Postoperative Analgesia Following Spinal Surgery: A Randomized, Double-Blinded, Controlled Trial

“…Several published studies in recent years have demonstrated the efficacy and safety of several adjuvants. [30][31][32] in prolonging the length of the analgesic effect of local anesthetic while reducing its doses to limit adverse effects. 33,34 Dexamethasone is an economical synthetic glucocorticoid that has a powerful antiinflammatory effect with a long half-life of 36 to 72 hours.…”

“…Additionally, there was a lower wound infection rate in the RD-group (0%) versus the R-group (0.7%, one patient). 31,42,44,47,[53][54][55][56][57][58] Therefore, dexamethasone as an adjuvant to incision-site infiltration is a safe method for the prevention of incision-site pain after spinal surgery.…”

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

“…Samoladas et al . [ 9 ] evaluated epidural steroids in analgesia of discectomy and stated that none of the patients in the intervention group and 12 patients in the control group needed more analgesics ( P = 0.01). Three hours after surgery, VAS was significantly lower in the intervention group compared to the control group ( P < 0.05).…”

Role of Epidural Steroid and Local Anesthetic in Post-Operative Outcome Following Lumber Discectomy

“…Though, immediately after the surgery, numerous subjects endured back pain and delayed discharge from hospital. Generally well-known and used approaches for treating pain postoperatively comprise oral painkillers such as opioids and incision infiltration with local anaesthetics [3][4] . Few authors have advocated the supplementary usage of epidural steroids 5 .…”