Peridural methylprednisolone and wound infiltration with bupivacaine for postoperative pain control after posterior lumbar spine surgery : A randomized double-blinded placebo-controlled trial

• Published in: Spine (Philadelphia, Pa. 1976) Pa. 1976), 2007-03, Vol.32 (6), p.609-617
• Main Authors: JIRARATTANAPHOCHAI, Kitti, JUNG, Surachai, THIENTHONG, Somboon, KRISANAPRAKORNKIT, Wimonrat, SUMANANONT, Chat, RIEW, K. Daniel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Analgesia, Epidural; Analgesia, Patient-Controlled; Analgesics, Opioid - therapeutic use; Anesthetics, Local - administration & dosage; Biological and medical sciences; Bupivacaine - administration & dosage; Cerebrospinal fluid. Meninges. Spinal cord; Disability Evaluation; Diseases of the osteoarticular system; Diseases of the spine; Diskectomy; Double-Blind Method; Drug Therapy, Combination; Female; Follow-Up Studies; Glucocorticoids - administration & dosage; Humans; Immunomodulators; Injections, Epidural; Laminectomy; Lumbar Vertebrae - surgery; Male; Medical sciences; Methylprednisolone - administration & dosage; Middle Aged; Morphine - therapeutic use; Nervous system (semeiology, syndromes); Neurology; Pain Measurement; Pain, Postoperative - prevention & control; Perioperative Care; Pharmacology. Drug treatments; Severity of Illness Index; Spinal Diseases - physiopathology; Spinal Diseases - surgery; Spinal Fusion; Time Factors; Treatment Outcome
• ISSN: 0362-2436; 1528-1159
• DOI: 10.1097/01.brs.0000257541.91728.a1

A randomized, double-blind placebo controlled trial in multimodal analgesia for postoperative pain was conducted. To examine whether combination of corticosteroid and bupivacaine administered in patients undergoing posterior lumbosacral spine surgery reduces postoperative morphine consumption, back and leg pain relief, and improves functional disability and general health status. Patients with lumbar spine surgery had moderate to severe postoperative pain. Administration of corticosteroid or injection of local anesthetic agent has been additive treatment methods for opioid drugs. There is uncertainty as to whether corticosteroid and bupivacaine combination improves outcomes in lumbosacral spine surgery. A total of 103 patients who were scheduled to undergo elective posterior lumbar discectomy, decompressive laminectomy with or without instrumented fusion for degenerative spinal diseases, received either methylprednisolone locally applied to the affected nerve roots (and bupivacaine was infiltrated into the wound) or injected placebo. Morphine consumption and pain scores were recorded at 1, 2, 3, 6, 12, 24, and 48 hours after surgery. Oswestry Index and Short Form SF-36 scores were recorded before surgery and at 1 and 3 months later. Demographic data between the 2 groups were comparable. The cumulative morphine dose and postoperative pain was significantly lower in the study group than in the placebo group (P = 0.01 and P = 0.001, respectively). When performing subgroup analyses, the beneficial effects were found in all groups of surgery but could not demonstrated statistically significant difference for all subgroup comparisons. There was no significant difference between the 2 groups with regard to pain on cough, Oswestry Index, and SF-36 scores. No complications were associated with the perioperative use of methylprednisolone or bupivacaine. Administration of methylprednisolone-bupivacaine provided a favorable effect immediately after posterior lumbosacral spine surgery for discectomy, decompression, and/or spinal fusion without complication.