Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Waqas, Muhammad; Shallwani, Hussain; Shamim, Muhammad Shahzad; Ahmad, Khabir

doi:10.4103/sni.sni_478_16

Cited by 19 publications

(16 citation statements)

References 19 publications

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“…[ 18 , 19 ] One meta-analysis reported that intraoperative ESI application offers some benefits in pain control with a significant reduction in the length of hospital stay. [ 20 ] The most recent meta-analysis indicated a lower back and leg pain score, decreased morphine consumption, and shorter hospital stay without difference in complications for ESI application compared to placebo after lumbar discectomy in lumbar disc herniation that was not detected in previous meta-analyses. [ 21 ] However, these meta-analyses still have many limitations.…”

Section: Introductionmentioning

confidence: 99%

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

Cai

Jiang²,

Qiu³

et al. 2020

Medicine

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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).

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Section: Introductionmentioning

confidence: 99%

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

Cai

Jiang²,

Qiu³

et al. 2020

Medicine

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“…Meta-analysis currently published [ 24 - 26 ] showed that it is safe to inject epidural steroids during lumbar spine surgery. According to the search, there was no meta-analysis on the outcomes of using epidural steroids after PTED, so this study is the first.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review

Song

et al. 2022

Korean J Pain

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Background: Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods: We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results: A total of 451 patients were included in three randomized and two nonrandomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions: Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.

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“…Computer navigation technology is “designed to improve the surgical performance and clinical outcome of knee replacement surgery,” and with this in mind, its use has increased in recent years. [ 15 – 20 ] In parallel, the volume of literature relating to computer navigation technology in this field has expanded greatly, most published work relating to component alignment, whereas very few studies have addressed functional outcome. [ 21 – 24 ] Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique.…”

Section: Discussionmentioning

confidence: 99%

Computer-navigated versus conventional total knee arthroplasty

Yu¹,

Sheng²,

Zhou³

2020

Medicine

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Background: The literature lacks studies that confirm whether the improved radiographic alignment that can be achieved with computer-navigated total knee arthroplasty (TKA) improves patients’ activities of daily living or the durability of total knee prostheses. Thus, in this protocol, we designed a randomized controlled trial to compare implant alignment, functional scores, and survival of the implant using computer-assisted surgery versus a conventional surgical technique. Methods: This prospective, blinded randomized controlled trial was conducted at our single hospital. This study was approved by the ethics committee of Jiaxing Second Hospital. The patient inclusion criteria were age 20 to 80 years’ old, a body mass index of ≤35 kg/m 2 , and consented for primary knee arthroplasty performed through a medial parapatellar approach by the senior author. We randomized consented study participants on a 1:1 ratio to 1 of 2 study groups using a computer-generated list of random numbers in varying block sizes. The primary outcome in this study was the Knee Injury and Osteoarthritis Outcome Score. Secondary outcomes were the Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, complications, and range of motion together with alignment and rotational positioning of the implant. Statistical significance was defined as a P value of ≤0.05. Conclusions: Authors hypothesized that computer-assisted surgery in primary TKA improves implant alignment, functional scores, and survival of the implant compared to the conventional technique.

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Perioperative steroids for lumbar disc surgery: A meta-analysis of randomized controlled trials

Cited by 19 publications

References 19 publications

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

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

Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review

Computer-navigated versus conventional total knee arthroplasty

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