The Oxiplex/SP gel-morphine compound after lumbar microdiscectomy in the management of postoperative pain. Report of 20 cases.
OBJECTIVE
Morphine-based compounds are used epidurally after lumbar microdiscectomy to minimize postoperative pain. After the withdrawal of ADCON-L we started to use Oxiplex (Oxiplex/SP Gel) as a barrier against epidural fibrosis and as a vehicle for morphine delivery.


METHODS
We administered epidurally morphine (1 mg) dissolved in Oxiplex gel to 20 consecutive patients after lumbar microdiscectomy, evaluating safety and analgesic effectiveness. Outcome measures adopted were (1) visual analog scale (VAS) of back and radicular pain, (2) straight leg raising (SLR) maneuver to assess evoked pain, (3) postoperative time to comfortable ambulation, (4) postoperative hospitalization, (5) postoperative request of analgesics, and (6) postoperative work time loss.


RESULTS
No complications, such as urinary retention, respiratory disturbances, or wound infections, were observed. During the first 24 hours the mean VAS was lower than the preoperative one (12.5 vs 77.3 mm, respectively; P < .01). The mean postoperative SLR was 62.25 degrees vs 38.74 degrees of preoperative period (P < .05). After a mean of 29.8 hours, patients were discharged. Twelve patients (60%) had low back and radicular pain relapse 36 to 72 hours after operation, requiring assumption of analgesics. At that time, 2 patients reported a level of pain higher than the preoperative one. At 1- and 2-week follow-up visits, mean VAS scores were 33.5 and 12.0 mm, respectively. The 2-week overall treatment satisfaction rating was excellent for 60% and good for 40%. Finally, the mean postoperative work time loss was 27 days.


CONCLUSIONS
The epidural application of Oxiplex-morphine compound after lumbar microdiscectomy was found to be safe. Regarding postoperative pain control, it was found to be effective only during the first 36 hours.
Mastronardi
Luciano
L
Department of Neurosurgery, S. Andrea Hospital, 00197 Roma, Italy. mastro@tin.it
Pappagallo
Marco
M
Tatta
Carlo
C
D002482:Cellulose / Q000008:administration & dosage* / Q000031:analogs & derivatives*; D019468:Disease Management; D017586:Diskectomy / Q000379:methods*; D005260:Female; D005782:Gels; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage*; D010149:Postoperative Pain / Q000188:drug therapy*; D011092:Polyethylene Glycols / Q000008:administration & dosage*; D011446:Prospective Studies
D005782:Gels; C406630:Oxiplex; D011092:Polyethylene Glycols; D009020:Morphine; D002482:Cellulose