The Influence of Epidural Steroids on Postoperative Pain and Hospital Stay in Patients Having a Single-Level Lumbar Discectomy

Authors

  • Shah Khalid
  • Abdul Aziz khan
  • Faiza Khalid
  • Shahbaz Ali Khan
  • Abdul Majid

DOI:

https://doi.org/10.36552/pjns.v26i3.769

Keywords:

Lumbar Discectomy, Epidural steroids, Post-Operative Pain

Abstract

Objective:   In this study, we looked at how intra-operative epidural steroids affected postoperative pain and stay duration in patients with unilateral single-level lumbar discectomy.

Material & Methods:  A randomized control trial was conducted at Ayub Teaching Hospital Abbottabad. Group A (n = 30) was given intraoperative epidural methylprednisolone, while group B (n = 30) was given normal saline only. The outcome was measured between the two groups in terms of postoperative pain (visual analog scale), time of mobilization, length of hospital stay, and duration to return to work.

Results:  At discharge, the VAS score in group A was 0.40 compared to 2.4 in group B (p = 0.000). At 2 weeks follow-up, the mean VAS score was 1.10 in group A in contrast to 1.4 in group B (p = 0.001). Patients who received local epidural methylprednisolone were mobilized after an average of 1 day, stayed for an average of 1.16 days, and returned to work following 18.2 days, whereas patients in the control group were mobilized after an average of 1.2 days, stayed for an average of 1.86 days and returned to work following 25.9 days. An incidental Dural tear occurs in 2 cases.

Conclusion:  Intra-operative epidural steroid is beneficial in reducing post-operative pain, hospital stay, and time to return to work. It allows early mobilization with enhanced recovery and few complications.

References

Qaseem A, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians Ann Intern Med. 2017; 166: 514-530.

Choi KC, Kim JS, Park CK. Percutaneous Endoscopic Lumbar Discectomy as an Alternative to Open Lumbar Microdiscectomy for Large Lumbar Disc Herniation. Pain Physician, 2016; 19: 291-300.

Allegri M, Montella S, Salici F, Valenta A, Marchesini M, compagnone C, et al. Mechanisms of low back pain: a guide for diagnosis and therapy. F1000 Res. 2016; 5: F1000 Faculty Rev-1530.

Deyo RA, Miza SK. Herniated Lumbar Intervertebral Disk. N Engl J Med. 2016; 374: 1763-72.

Wanivenhaus F, Buck FM, Betz M, Farshad-Amacker NA, Farshad M. Reliability of postoperative MR imaging in the determination of level and side of lumbar spinal decompression surgery. Acta Radiologica. 2017; 58 (5): 581–5.

Gugliotta M, da Costa BR, Dabis E, Theiler R, Juni P, Rechenbach S, et al. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. BMJ Open, 2016; 6: 012938.

Drazin D, Ugiliweneza B, Al-Khouja L, Yang D, Johnson P, Kim T, et al. Treatment of Recurrent Disc Herniation: A Systematic Review. Cureus, 2016; 8 (5): 622.

Tacconi L. Lumbar discectomy: has it got any ill-effects? J Spine Surg. 2018; 4 (3): 677–80.

Kosztowski T, Gokaslan ZL. Determining the Extent of Lumbar Discectomy in Patients with Herniated Lumbar Discs. Neurosurg. 2016; 1: 1.

Kumari K, Kamal M, Singariya G, Kishan R, Garg S, Thanvi S. Effect of epidural levobupivacaine with or without dexamethasone soaked in gelfoam for postoperative analgesia after lumbar laminectomy: A double blind, randomised, controlled trial. Indian J Anaesth. 2018; 62 (7): 509–15.

Akinduro OO, Miller BA, Haussen DC, Pradilla G, Ahmad FU. Complications of intraoperative epidural steroid use in lumbar discectomy: a systematic review and meta-analysis, Neurosurgical Focus FOC. 2015; 39 (4): 12.

Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017; 10: 2287–98.

Aljabi Y, Shawarby AE, Cawley DT, Aherne. Effect of epidural methylprednisolone on post-operative pain and length of hospital stay in patients undergoing lumbar microdiscectomy. The Surgeon, 2015; 13 (5): 245-9.

Cornefjord M, Olmarker K, Otani K, Rydevik B. Nucleus Pulposus-Induced Nerve Root Injury: Effects of diclofenac and Ketoprofen. Eur Spine J. 2002; 11 (1): 57–61.

rönblad M, Habtemariam A, Virri J, Seitsalo S, Vanharanta H, Guyer R. Complement Membrane Attack Complexes in Pathologic Disc Tissues. Spine, 2003; 28 (2): 114–118.

Cornefjord M, Olmarker K, Otani K, Rydevik B. Nucleus Pulposus-Induced Nerve Root Injury: Effects of diclofenac and Ketoprofen. Eur Spine J. 2002; 11 (1): 57–61.

Foulkes GD, Robinson JS Jr. Intraoperative dexamethasone irrigation in lumbar microdiskectomy. Clin Orthop. 1989; 261: 224–8.

Gibson JN, Grant IC, Waddell G. Surgery for lumbar disc prolapse. Cochrane Database Syst Rev. 2000. CD001350.

Weinstein JN, Lurie JD, Tosteson TD, Skinner JS, Hanscom B, Tosteson AN, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) observational cohort. JAMA. 2006; 296 (20): 2451-9.

Jamjoom BA, Jamjoom AB. Efficacy of intraoperative epidural steroids in lumbar discectomy: a systematic review. BMC Musculoskelet Disord. 2014; 146 (15): 1471-2474.

Cai J, Jiang W, Qiu B, Song Y. Efficacy and safety of epidural steroid injection following discectomy for patients with lumbar disc herniation: a protocol. Medicine, 2020; 99 (29): e21220.

Lowell TD, Errico TJ, Eskenazi MS. Use of epidural steroids after discectomy may predispose to infection. Spine, 2000; 25 (4): 516_9.

Ishfaq, A., & Shahzad, M. Efficacy of intra operative use of triamcinolone in lumbar discectomy. PAFMJ. 2020; 70 (6): 1908-12.

Hassanzadeh, Hamid, Bell, Joshua, Bhatia, Manminder DO, Puvanesarajah, Varun. Journal of the American Academy of Orthopaedic Surgeons AAOS. 2021; 29 (6): e279-e286.

Tafazal SI, Sel PJ. Incidental durotomy in lumbar spine surgery: incidence and management. Eur Spine J. 2005; 14 (3): 287–290.

Downloads

Published

2022-09-30

Issue

Section

Original Articles