Short-Term Clinical Efficacy of Lacosamide in Orthopedic Spine Patients with Acute Sciatica: A Prospective Observational Study at Akhtar Saeed Trust Teaching Hospital, Lahore

Abstract

Objective:  To evaluate the short-term clinical efficacy and tolerability of intravenous lacosamide in orthopedic spine patients presenting with acute sciatica.

Materials and Methods:  This prospective observational study was conducted at the Department of Orthopedic Surgery, Akhtar Saeed Trust Teaching Hospital, Lahore, from January 2023 to January 2024. One hundred adult patients (20–65 years) with acute lumbosacral radiculopathy were included. All patients received intravenous lacosamide 200 mg diluted in 100 mL normal saline, administered twice daily for three consecutive days. Clinical outcomes were assessed at baseline and on day 4 using the Numerical Rating Scale (NRS) for pain, Oswestry Disability Index (ODI), Straight Leg Raise (SLR) test, and Claudication Distance (CD). Statistical analysis was performed using paired t-tests.

Results:  After 4 days of treatment, significant improvements were observed across all outcome measures. Mean NRS decreased from 8.2 ± 1.1 to 3.1 ± 1.4 (p < 0.001), and mean ODI reduced from 58.7 ± 11.3% to 29.6 ± 10.8% (p<0.001). Mean SLR angle increased from 42.6 ± 10.5° to 68.3 ± 11.9° (p<0.001), while mean claudication distance improved from 145.2 ± 48.3 m to 266.4 ± 59.8 m (p < 0.001). Adverse effects were mild and included dizziness (8%), nausea (5%), and somnolence (4%), with no serious events.

Conclusion:  Short-term intravenous lacosamide significantly improved pain, functional disability, and objective neurological parameters in patients with acute sciatica and was well tolerated, supporting its role as an adjunct in acute radicular pain management.