title: Postoperative lumbar microdiscectomy pain. Minimalization by irrigation and cooling.
abstract: METHODS
  Seventy patients undergoing de novo lumbar microdiscectomy were prospectively randomized into a control group and a group in which cold intraoperative wound irrigation along with postoperative wound cooling was used. Postoperative analgesia requirements and length of hospital stay were analyzed and correlated.
  
  
  OBJECTIVE
  To evaluate the role of intraoperative cold irrigation and postsurgical cooling in minimizing postoperative lumbar discectomy pain.
  
  
  BACKGROUND
  Regulated hypothermia has been used frequently in pain reduction; however, the efficacy of such a strategy in lumbar disc procedures has not been established.
  
  
  METHODS
  Seventy patients (43 men and 27 women), operated on the first time for lumbar disk herniation were prospectively randomized into two groups. A standard microdiscectomy was performed on all patients. In cohort A the wound site was irrigated with a cold (18 C) 5% bacitracin solution for 5 minutes. Additionally, a cooling microtemperature pump was placed on the wound site for 24 hours after surgery. The patients in the control group (cohort B) were treated in a standard fashion without additional hypothermic therapy. All patients received postoperative analgesia through a self-administered morphine pump. The amount of postoperative analgesia received was calculated in morphine equivalents per kilogram. The length of hospital stay was also noted.
  
  
  RESULTS
  The total amount of pain medication was significantly smaller in cohort A than in the control group (cohort B). For the statistical analysis of the results, covariate analyses for both the length of hospital stay and the morphine dose were used, demonstrating a statistically significant difference with P = 0.0001. No postoperative wound infection was noted in either group.
  
  
  CONCLUSIONS
  Intraoperative and postoperative wound site cooling is a safe, inexpensive, and efficient therapeutic method. It reduces the patients' postoperative pain, promotes earlier ambulation and decreases the length of hospital stay.
authors.affiliation: Department of Neurological Surgery, Medical Center of Central Georgia, Macon, USA.
authors.forename: K N
authors.initials: KN
authors.lastname: Fountas
authors.forename: E Z
authors.initials: EZ
authors.lastname: Kapsalaki
authors.forename: K W
authors.initials: KW
authors.lastname: Johnston
authors.forename: H F
authors.initials: HF
authors.lastname: Smisson
authors.forename: R L
authors.initials: RL
authors.lastname: Vogel
authors.forename: J S
authors.initials: JS
authors.lastname: Robinson
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D017586:Diskectomy; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007432:Intraoperative Period; D007902:Length of Stay; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000188:drug therapy / Q000517:prevention & control*; D011184:Postoperative Period; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D009020:Morphine