Postoperative Narcotic Requirement After Microscopic Lumbar Discectomy is Not Affected by Intraoperative Ketorolac or Bupivacaine

Mack, Patricia Fogarty; Hass, David J.; Lavyne, Michael H.; Snow, Robert B.; Lien, Cynthia A.

doi:10.1097/00007632-200103150-00021

Cited by 40 publications

(31 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…19 In contrast to these findings, Mack et al was not able to demonstrate a significant difference in morphine requirements following a single-level microsurgical lumbar discectomy when a one time dose of Ketorolac was compared with intramuscular bupivacaine or placebo. 20 In this prospective, randomized, double-blinded, placebo trial, our data suggests that Ketorolac is an effective analgesic agent following lumbar decompression laminectomy for spinal stenosis. In this study, patients who were administered Ketorolac on a scheduled basis in the postoperative period had a significantly lower morphine requirement at all postoperative time points when compared with patients randomized to placebo (Table 2).…”

Section: Discussionmentioning

confidence: 92%

Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery

Cassinelli

Dean²,

Garcia³

et al. 2008

Spine

View full text Add to dashboard Cite

There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative Hemovac drain output between study groups. Morphine equivalent requirements were significantly less at all predetermined time points in addition to the overall hospital morphine requirement in patients randomized to receive Ketorolac. Visual Analog Pain Scores were significantly lower in patients randomized to receive Ketorolac immediately postoperative in addition to 4, 12, and 16 hours postoperative. There were no identifiable postoperative complications associated with the use of Ketorolac. CONCLUSION.: Intravenous Ketorolac seems to be a safe and effective analgesic agent following multilevel lumbar decompressive laminectomy. Patients can expect lower morphine requirements and better pain scores throughout their postoperative course.

show abstract

Section: Discussionmentioning

confidence: 92%

Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery

Cassinelli

Dean²,

Garcia³

et al. 2008

Spine

View full text Add to dashboard Cite

show abstract

“…13 There is evidence in the literature to support wound infiltration with bupivacaine for microdiscectomy. 14,15 In contrast, Mack et al 16 did not find the intraoperative use of ketorolac or bupivacaine to be beneficial in reducing postoperative morphine requirements. Rather, severe pain prior to surgery was the major determinant of postoperative morphine consumption.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 96%

“…Rather, severe pain prior to surgery was the major determinant of postoperative morphine consumption. 16 Other methods advanced for the management of pain in these patients include wound irrigation with cold bacitracin and postoperative cooling, 17 and intrathecal morphine. 18,19 Although useful, intrathecal morphine is not suitable for the ambulatory patient for fear of delayed respiratory depression.…”

Section: Me Et Th Ho Od Ds Smentioning

confidence: 99%

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy

Shaikh

Chung

Imarengiaye

et al. 2003

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

“…10 Also excluded were studies in which the patients were treated with epidural nonsteroidal analgesics. 26,34 However, we did include trials in which a combination of steroids and local anesthetics was used, as the focus of our review was complications from epidural steroids. 5,9,15,17,28 We did not include trials in which the full text was not available 14,23,27,30 or those not written in the English language.…”

Section: Eligibility Criteriamentioning

confidence: 99%

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

Akinduro

Miller²,

Haussen

et al. 2015

FOC

View full text Add to dashboard Cite

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.

show abstract

Postoperative Narcotic Requirement After Microscopic Lumbar Discectomy is Not Affected by Intraoperative Ketorolac or Bupivacaine

Abstract: Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.

Cited by 40 publications

References 9 publications

Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery

Ketorolac Use for Postoperative Pain Management Following Lumbar Decompression Surgery

Pain, nausea, vomiting and ocular complications delay discharge following ambulatory microdiscectomy

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

Contact Info

Product

Resources

About