Glasser R S, Knego R S, Delashaw J B, Fessler R G
Department of Neurosurgery, University of Florida, Gainesville.
J Neurosurg. 1993 Mar;78(3):383-7. doi: 10.3171/jns.1993.78.3.0383.
The introduction of microdiscectomy to lumbar spine surgery has resulted in a significant decrease in postoperative pain and length of hospital stay. Intraoperative application of long-acting local anesthetic agents has been used for many general and neurosurgical procedures for the management of postoperative pain. In addition, many surgeons routinely use intraoperative corticosteroids during lumbar discectomy to reduce traumatic nerve root inflammation. However, the efficacy of intraoperative long-acting local anesthetic agents and corticosteroids for reduction of postoperative discomfort has not been reported for lumbar discectomy. This study evaluated 32 patients at a university-based Veterans Administration hospital undergoing lumbar microdiscectomy. All 32 patients presented with radicular symptoms and had radiographic confirmation of a herniated nucleus pulposus. These patients were divided into three groups. Group 1 (12 patients) received 160 mg intramuscular Depo-Medrol (methylprednisolone acetate) and 250 mg intravenous Solu-Medrol (methyl-prednisolone sodium succinate) at the start of the operation. A macerated fat graft soaked in 80 mg Depo-Medrol was placed over the affected nerve root following discectomy. In addition, 30 ml of 0.25% bupivacaine was infiltrated into the paraspinal musculature at skin incision and during closure. Group 2 (10 patients) received 30 ml of 0.25% bupivacaine infiltrated into the paraspinal musculature at skin incision and at closure. In this group of patients, a saline-soaked fat graft was placed over the affected nerve root. Group 3 (10 patients) acted as a control group, undergoing lumbar microdiscectomy without corticosteroids or bupivacaine. Patients receiving bupivacaine and corticosteroids (Group 1) had a statistically significantly shorter hospital stay (1.4 days) compared to the control group (4.0 days) (p = 0.0004, Mann-Whitney U-test). Patients in Group 1 required less postoperative narcotic analgesia than the other groups. Finally, a larger percentage of patients in Group 1 reported complete relief of back and radicular pain on postoperative Day 1 compared to other groups. Postoperative complications and functional outcome were not different between the groups. These results indicate that the combination of long-acting anesthetic agents and corticosteroids can reduce postoperative discomfort and subsequently the length of postoperative hospital stay.
腰椎间盘切除术引入腰椎脊柱手术，已使术后疼痛和住院时间显著缩短。长效局部麻醉剂的术中应用已用于许多普通外科和神经外科手术，以管理术后疼痛。此外，许多外科医生在腰椎间盘切除术中常规使用术中皮质类固醇，以减轻创伤性神经根炎症。然而，腰椎间盘切除术中长效局部麻醉剂和皮质类固醇减少术后不适的疗效尚未见报道。本研究评估了一家大学附属医院退伍军人管理局医院接受腰椎间盘显微切除术的32例患者。所有32例患者均有神经根症状，且经影像学证实有髓核突出。这些患者被分为三组。第一组（12例患者）在手术开始时接受160mg肌肉注射的得宝松（醋酸甲泼尼龙）和250mg静脉注射的甲强龙（甲泼尼龙琥珀酸钠）。椎间盘切除术后，将浸泡在80mg得宝松中的碎脂移植物置于受影响的神经根上。此外，在皮肤切口和缝合时，将30ml 0.25%布比卡因浸润到椎旁肌肉组织中。第二组（10例患者）在皮肤切口和缝合时，将30ml 0.25%布比卡因浸润到椎旁肌肉组织中。在这组患者中，将盐水浸泡的脂肪移植物置于受影响的神经根上。第三组（10例患者）作为对照组，接受无皮质类固醇或布比卡因的腰椎间盘显微切除术。与对照组（4.0天）相比，接受布比卡因和皮质类固醇治疗的患者（第一组）住院时间在统计学上显著缩短（1.4天）（p = 0.0004，曼-惠特尼U检验）。第一组患者术后所需的麻醉性镇痛比其他组少。最后，与其他组相比第一组中更大比例的患者在术后第1天报告背部和神经根疼痛完全缓解。各组之间术后并发症和功能结果无差异。这些结果表明，长效麻醉剂和皮质类固醇的联合应用可减少术后不适，进而缩短术后住院时间。
