Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: A randomized controlled trial

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dc.contributor.authorMirzai H.
dc.contributor.authorTekin I.
dc.contributor.authorAlincak H.
dc.date.accessioned2024-07-22T08:25:12Z
dc.date.available2024-07-22T08:25:12Z
dc.date.issued2002
dc.description.abstractStudy Design. A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery. Summary of Background Data. The anti-inflammatory mechanism of corticosteroids is considered to be caused by the inhibition of phospholipase A2, which plays an important role in the pain mechanism of lumbar disc problems. Although some authors have demonstrated that the use of intramuscular bupivacaine during lumbar discectomy resulted in a marked reduction of postoperative back pain, others have reported that the key intervention was probably the administration of epidural corticosteroid. The coadministration of these two drugs in lumbar disc surgery for the relief of postoperative back pain has yet not been studied adequately. Objectives. Assessment of the combined use of perioperative corticosteroids and bupivacaine for the relief of postoperative pain after lumbar disc surgery. Methods. Forty-four selected patients had acute-onset single-level unilateral herniated nucleus pulposus that were refractory to conservative management. All patients underwent lumbar disc surgery under standard general anesthesia. Before surgical incision, the skin and subcutaneous tissues were infiltrated with 10 mL of 1% lidocaine with 1:200,000 adrenaline to produce local vasoconstriction. During wound closure, 20 mL 0.9% saline in Group 1 (n = 22) and 20 mL 0.25% bupivacaine in Group 2 (n = 22) were injected into the paravertebral muscles and subcutaneus tissues. In addition, a piece of autologous fat taken from the wound was first soaked in 40 mg of methylprednisolone for 10 minutes, then placed over the exposed nerve root, and the remaining steroid was flushed into the wound in Group 2. The wound was closed after drug administration in both groups. In the postoperative period, all patients received 100 mg of meperidine intramuscularly when needed and were allowed to receive a second dose at least 4 hours later than the first dose for postoperative analgesia. Postoperative back pain intensity, heart rate, and mean arterial pressure were assessed 1, 3, 6, and 12 hours after the conclusion of surgery. Results. Visual analog scale pain scores for the postoperative recordings were lower in Group 2 than in Group 1, but these findings were not statistically significant. Patients in Group 1 received 77.3 ± 48.8 mg meperidine, and those in Group 2 received 31.8 ± 45.5 mg meperidine, for pain medication in the first 12 hours (P < 0.05). Heart rate and mean arterial pressure were not significantly different between the two groups in all recording periods. Conclusion. It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.
dc.identifier.DOI-ID10.1097/00007632-200202150-00003
dc.identifier.issn03622436
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/20314
dc.language.isoEnglish
dc.subjectAdrenal Cortex Hormones
dc.subjectAdult
dc.subjectAnalgesics, Opioid
dc.subjectAnesthetics, Local
dc.subjectBlood Pressure
dc.subjectBupivacaine
dc.subjectDiskectomy
dc.subjectDrug Administration Routes
dc.subjectDrug Therapy, Combination
dc.subjectFemale
dc.subjectHeart Rate
dc.subjectHumans
dc.subjectIntervertebral Disk Displacement
dc.subjectLow Back Pain
dc.subjectLumbosacral Region
dc.subjectMagnetic Resonance Imaging
dc.subjectMale
dc.subjectMeperidine
dc.subjectMethylprednisolone
dc.subjectPain Measurement
dc.subjectPain, Postoperative
dc.subjectPerioperative Care
dc.subjectTomography, X-Ray Computed
dc.subjectTreatment Outcome
dc.subjectadrenalin
dc.subjectbupivacaine
dc.subjectcorticosteroid
dc.subjectdiazepam
dc.subjectfentanyl
dc.subjectlidocaine
dc.subjectmethylprednisolone
dc.subjectopiate derivative
dc.subjectpethidine
dc.subjectphospholipase A2
dc.subjectpropofol
dc.subjectvecuronium
dc.subjectadipose tissue
dc.subjectadult
dc.subjectarticle
dc.subjectback muscle
dc.subjectbackache
dc.subjectclinical article
dc.subjectclinical trial
dc.subjectcontrolled clinical trial
dc.subjectcontrolled study
dc.subjectcorticosteroid therapy
dc.subjectdrug efficacy
dc.subjectfemale
dc.subjectgeneral anesthesia
dc.subjectheart rate
dc.subjecthuman
dc.subjectintervertebral diskectomy
dc.subjectlocal anesthesia
dc.subjectlumbar disk hernia
dc.subjectmale
dc.subjectmean arterial pressure
dc.subjectnucleus pulposus
dc.subjectperoperative care
dc.subjectpostoperative analgesia
dc.subjectpostoperative complication
dc.subjectpostoperative pain
dc.subjectpriority journal
dc.subjectprospective study
dc.subjectrandomized controlled trial
dc.subjectstatistical analysis
dc.subjectvasoconstriction
dc.subjectwound closure
dc.titlePerioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: A randomized controlled trial
dc.typeArticle

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