Perioperative use of corticosteroid and bupivacaine combination in lumbar disc surgery: a randomized controlled trial.
METHODS
A prospective and controlled study of perioperative use of combined local anesthetic and corticosteroid in lumbar disc surgery.


BACKGROUND
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.


OBJECTIVE
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.


CONCLUSIONS
It is concluded that the perioperative use of bupivacaine and corticosteroids during lumbar discectomy maintains effective postoperative analgesia and decreases opioid usage without complications.
Mirzai
Hasan
H
Anesthesiology and Reanimation, Celal Bayar University Medical Faculty, Manisa, Turkey.
Tekin
Idil
I
Alincak
Handan
H
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000187:drug effects; D002045:Bupivacaine / Q000008:administration & dosage*; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000175:diagnosis / Q000601:surgery*; D017116:Low Back Pain / Q000209:etiology / Q000517:prevention & control; D008161:Lumbosacral Region; D008279:Magnetic Resonance Imaging; D008297:Male; D008614:Meperidine / Q000627:therapeutic use; D008775:Methylprednisolone / Q000008:administration & dosage; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D019990:Perioperative Care; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D008614:Meperidine; D008775:Methylprednisolone; D002045:Bupivacaine