Intraoperative Epidural Steroids in Lumbar Discectomy
Intraoperative Epidural Steroids in Lumbar Discectomy
The literature search yielded 16 studies of lumbar discectomy and intraoperative application of epidural steroids that were considered suitable for review. These included a total of 693 patients that had lumbar discectomy and received intraoperative epidural steroids and 617 controls. The steroids used were methylprednisolone 40 mg, methylprednisolone 80 mg and dexamethasone 16 mg. The additional medications used included epidural fentanyl and morphine as well as IM bupivacaine and IM and IV methylprednisolone. The postoperative pain scores were assessed by Visual Analog Scale (VAS), by McGill Pain Questionnaire (MPQ), by Aberdeen Back Pain Index (ABPI) or by using a Numerical Rating Scale (NRS) from 0 to 10, from 0 to 3 and from I to V. Some authors did not state their methods of grading pain.
Table 1 summarizes all the significant and non-significant pain scores for treated patients and controls at the specified postoperative times as documented by the authors and the bias risk grade for each series. Analysis of the series reporting significant and non-significant reduction in pain scores during the early, intermediate and late postoperative stages is summarized in Table 2 . Analysis of the series reporting significant and non-significant reduction in the consumption of postoperative analgesia and in the hospital stay is summarized in Table 3 . None of trials reported a significant steroids-related increased rate of infection or recurrences. There were few reports of complications such as superficial wound infection, erythema, serous discharge, reoperation for recurrence and readmission for pain management that were observed nearly equally in both groups.
Results
Study Selection and Characteristics
The literature search yielded 16 studies of lumbar discectomy and intraoperative application of epidural steroids that were considered suitable for review. These included a total of 693 patients that had lumbar discectomy and received intraoperative epidural steroids and 617 controls. The steroids used were methylprednisolone 40 mg, methylprednisolone 80 mg and dexamethasone 16 mg. The additional medications used included epidural fentanyl and morphine as well as IM bupivacaine and IM and IV methylprednisolone. The postoperative pain scores were assessed by Visual Analog Scale (VAS), by McGill Pain Questionnaire (MPQ), by Aberdeen Back Pain Index (ABPI) or by using a Numerical Rating Scale (NRS) from 0 to 10, from 0 to 3 and from I to V. Some authors did not state their methods of grading pain.
Results of Individual Studies and Risk of Bias
Table 1 summarizes all the significant and non-significant pain scores for treated patients and controls at the specified postoperative times as documented by the authors and the bias risk grade for each series. Analysis of the series reporting significant and non-significant reduction in pain scores during the early, intermediate and late postoperative stages is summarized in Table 2 . Analysis of the series reporting significant and non-significant reduction in the consumption of postoperative analgesia and in the hospital stay is summarized in Table 3 . None of trials reported a significant steroids-related increased rate of infection or recurrences. There were few reports of complications such as superficial wound infection, erythema, serous discharge, reoperation for recurrence and readmission for pain management that were observed nearly equally in both groups.
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