Perioperative Use of Corticosteroid and Bupivacaine Combination in Lumbar Disc Surgery

Mirzai, Hasan; Tekin, İdil; Alincak, Handan

doi:10.1097/00007632-200202150-00003

Cited by 105 publications

(82 citation statements)

References 16 publications

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“…The results are in keeping with the local application of corticosteroid at the surgical site following lumbar discectomy. 21,22 In contrast to the findings from our study, intrathecal administration of corticosteroids in a rat model has been shown to have a mild effect on nociceptor-driven spinal sensitization. 14 One possible explanation for this different response to neuraxial steroid administration is that the dose of methylprednisolone and triamicinolone in a rat model was insufficient to prevent the nociceptor-driven spinal sensitization.…”

Section: (D1) Group 3 (D2) (N = 30) (N = 30) (N = 30) Vas (Rest) Vas contrasting

confidence: 99%

L’administration péridurale de dexaméthasone réduit la douleur et la demande d’analgésiques postopératoires

Thomas

Beevi

2006

Can J Anesth/J Can Anesth

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Purpose: Epidural steroids may have potential advantages for providing postoperative analgesia. We therefore undertook a study to evaluate the efficacy of epidurally administered dexamethasone in reducing postoperative morphine requirements, as a measure of analgesia following laparoscopic cholecystectomy. Methods:In a randomized, double-blind study, 94 patients undergoing laparoscopic cholecystectomy were randomly assigned to one of three groups. Group 1 (Control) patients received dexamethasone 5 mg iv with epidural injection of 0.25% bupivacaine 8 mL and normal saline 2 mL, Group 2 (D1) patients received normal saline 2 mL iv with epidural injection of 0.25% bupivacaine 8 mL and dexamethasone 5 mg in normal saline 2 mL, and Group 3 (D2) patients received normal saline 2 mL iv with epidural injection of dexamethasone 5 mg in normal saline 10 mL. After surgery, morphine 2-4 mg iv was administered as needed for analgesia. Postoperative morphine requirements, visual analogue scale (VAS) pain scores at rest and with effort, and time to first analgesic administration were recorded by a blinded observer. Results:Total morphine consumption for the first 24 hr following surgery was lower in both epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reduction in morphine consumption in Group D1 was 53.9% and in Group D2 was 52.9% in the first 24 hr. Postoperatively at 12 hr, 18 hr and 24 hr, the VAS scores at rest and during effort were also lower in the epidural dexamethasone groups (D1, D2) compared to the control group (P < 0.05). The percentage reductions in VAS scores with effort at 12 hr, 18 hr and 24 hr in Group D1 were 50%, 52.9% and 50% respectively, and in Group D2 percentage reductions in pain scores with effort were 54.8%, 58.8% and 55.5% at corresponding sampling intervals. Conclusion:Preoperative epidural administration of dexamethasone 5 mg, with or without bupivacaine, reduces postoperative pain and morphine consumption following laparoscopic cholecystectomy. Objectif

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Section: (D1) Group 3 (D2) (N = 30) (N = 30) (N = 30) Vas (Rest) Vas contrasting

confidence: 99%

L’administration péridurale de dexaméthasone réduit la douleur et la demande d’analgésiques postopératoires

Thomas

Beevi

2006

Can J Anesth/J Can Anesth

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“…Several other reports also suggested the efficacy of local or systemic steroids in the immediate postoperative period. In various studies [6,9,13,14], saline or salinesoaked fat graft or absorbable gel was used in the control group and the effects were recorded. However in clinical practice we never inject saline or saline-soaked fat graft or Gelfoam if we do not intend to apply a local steroid or other agents.…”

Section: Discussionmentioning

confidence: 99%

“…Perioperative use of corticosteroids and bupivacaine [6][7][8][9]14] has been reported as effective analgesia and decreases opioid or analgesic use without complications. Local or systematic use of various steroids [1,13] is described in the literature in lumbar disc patients.…”

Section: Introductionmentioning

confidence: 99%

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Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

Modi

Chung

Yoon

et al. 2008

International Orthopaedics (SICOT)

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This prospective, randomised case-control study was made to determine effectiveness of low-dose DepoMedrol applied to the affected nerve root after discectomy. Fifty seven patients with L4-5 or L5-S1 single level disc herniation with unilateral leg pain were selected for the study and were divided in two groups. Twenty eight patients were in the control group and 29 in the steroid group. Discectomy was done after flavotomy in all patients. In the steroid group low-dose 40 mg Depo-Medrol soaked Gelfoam was applied over the affected nerve root after discectomy while in the control group neither saline nor plain Gelfoam was applied to affected root. Postoperatively, patients were asked to evaluate backache using VAS which was compared statistically using the unpaired t test. Statistical difference was significant (p<0.0001) regarding postoperative VAS during the first month and then it became insignificant. Results show that local application of low-dose Depo-Medrol is helpful in reducing immediate postoperative backache after discectomy, but it is not effective in the long-term.Résumé Il s'agit d'une étude prospective randomisée pour montrer les effets de petite dose de dépo-Médrol appliqué sur les racines nerveuses après discectomie. 57 patients présentant une hernie discale L4-L5 ou L5-S1, avec une douleur unilatérale ont été sélectionnés pour cette étude. Deux groupes ont été constitués, 28 patients constituant le groupe contrôle et 29 patients le groupe stéroïde. La discectomie a été réalisée après l'ablation du ligament jaune chez tous les patients. Dans le groupe stéroïde une petite dose de 40 mg de Dépo-Médrol sous forme de gel a été appliquée sur la racine nerveuse après discectomie et sur le groupe contrôle un gel d'origine saline. En postopératoire les patients ont été questionnés pour évaluer les lombalgies en utilisant la méthode VAS avec tests statistiques. Les résultats sont statistiquement différents en postopératoire (p<0,0001), au cours du premier mois puis petit à petit la différence devient non significative. Ces résultats montrent donc que l'application locale d'une petite dose de dépo-médrol permet de diminuer la douleur post-opératoire immédiate après discectomie. Mais ceci n'entraîne pas d'amélioration à long terme.

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“…They relive pain by reducing inflammation and blocking transmission of nociceptive c-fibres and by suppressing ectopic neural discharge [9]. Some study demonstrated the analgesic effect of systemic corticosteroid in combination with bupivacaine [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Supraclavicular Brachial Plexus Block with and without Dexamethasone as an Adjuvant to local anaesthetics: a Comparative Study

Dhumane

Shakir

2016

Int J of Biomed & Adv Res

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Aim and Objectives: To assess the effect of dexamethasone on onset and duration of anaesthesia as well as duration of analgesia when added to local anaesthetic solution for supraclavicular brachial plexus block. Methods: A randomized comparative study included total 60 patients of either sex, age between 18-70 years belonging to ASA Grade I and II undergoing elective or emergency surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly divided in group A (40 ml volume of lignocaine 2% with adrenaline (1:200000) + 0.5% bupivacaine) and group B (40 ml volume of lignocaine 2% with adrenaline (1:200000) + 0.5% bupivacaine with dexamethasone 8 mg). The onset and duration of sensory and motor block as well as duration of analgesia in the two groups were compared and any complications of the procedure were noted. Result: Group B had early onset and prolonged duration of sensory and motor block as well as prolonged duration of analgesia as compared to group A. None of the patients had bradycardia, hypotension or any other side effects. Conclusion:We concluded that addition of 8 mg dexamethasone to local anaesthetics in supraclavicular brachial plexus block reduces the time to onset of sensory and motor blockage and prolonged duration of postoperative analgesia.

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Perioperative Use of Corticosteroid and Bupivacaine Combination in Lumbar Disc Surgery

Abstract: It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.

Cited by 105 publications

References 16 publications

L’administration péridurale de dexaméthasone réduit la douleur et la demande d’analgésiques postopératoires

L’administration péridurale de dexaméthasone réduit la douleur et la demande d’analgésiques postopératoires

Local application of low-dose Depo-Medrol is effective in reducing immediate postoperative back pain

Supraclavicular Brachial Plexus Block with and without Dexamethasone as an Adjuvant to local anaesthetics: a Comparative Study

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