Patients Undergoing Lumbar Laminectomy Research Articles

Progression to fusion after lumbar laminectomy for degenerative lumbar spondylolisthesis: Rate and risk-factors. A national database study

ObjectiveLumbar laminectomy is often utilized in the treatment of degenerative lumbar spondylolisthesis. Risk factors that contribute to reoperation rates, in particular to progression to fusion, are poorly understood. We aimed to identify rate and risk factors of lumbar fusion surgery following lumbar laminectomy for the treatment of degenerative lumbar spinal spondylolisthesis. MethodsOur sample was obtained from the national MarketScan Commercial Claims and Encounters Database. We reviewed patients undergoing lumbar laminectomy for stable degenerative lumbar spondylolisthesis (Grade-1) at one or two levels between January 2007 and December 2016. ResultsA total of 33,681 patients were included. By 2 years after the index operation, 2.48 % of patients had required lumbar fusion surgery. Female sex was associated with lower odds (OR 0.8, 95 %CI 0.7–0.9) of reoperation for fusion. Diabetes (OR 1.2, 95 %CI 1.1–1.4), rheumatoid arthritis (OR 1.5, 95 %CI 1.2–1.7) and clinical presentation with LBP (OR 2.1, 95 %CI 1.6–2.9), lower extremity weakness (OR 1.4, 95 %CI 1.1–1.5), as well as occurrence of a postoperative neurological complications (OR 2.0, 95 %CI 1.1–3.4) increased the odds ratio for requiring fusion surgery within two years after lumbar laminectomy. ConclusionIn this large cross-sectional sample of a national claims database consisting of lumbar laminectomy patients for the treatment of spondylolisthesis, approximately 2.5 % required subsequent lumbar fusion. Several modifiable risk factors for fusion progression were identified, which may guide clinicians in shared decision-making and to help identify patients with elevated post-operative risk providing potential leverage point for prevention.

Comparison of the effect of dexmedetomidine with remifentanil on pain after lumbar laminectomy in patients under general anesthesia

Backgrounds and objectives: Acute postoperative pain is still an issue in patients undergoing lumbar laminectomy surgery. We compared the effects of remifentanil and dexmedetomidine on pain intensity as well as the analgesic requirements in patients undergoing spinal surgery. Methods: This randomized clinical trial study was conducted on 60 patients in the age range of 20 to 60 years with ASA class one and two of the American Anesthesia Association under elective lumbar vertebrae laminectomy. Patients were divided into two groups: Remifentanil (group R) and Dexmedetomidine (group D). Before induction of anesthesia in R group patients, 0.01 می g / kg / min remifentanil was used. In group D, 0.3 dexmedetomidine was injected from µg / min / 50kg using a syringe pump. Postoperative pain score, nausea, and vomiting, mean arterial blood pressure, and heart rate at recovery times, 6, 12, and 24 hours after surgery were recorded. Results: The propofol infusion rate was significantly lower in the DEX group than in group R (P = 0.001). Pain scores except for 6h after surgery was significantly lower in group DEX. Analgesic consumption was significantly lower in group DEX (P=0.021). Mean arterial pressure during surgery, after laryngoscopy, and recovery was significantly lower in group DEX (P<0.05). The mean heart rate after laryngoscopy was significantly lower in group DEX (P=0.033). Conclusion: Intraoperative infusion of DEX improved hemodynamic parameters during surgery and decreased pain score, morphine use after lumbar laminectomy surgery.

Etoricoxib Can Reduce Post-Operative Morphine Consumption and Pain Score in Patients Undergoing Lumbar Laminectomy Compare to Acetaminophen: A Randomized Trial.

Randomized controlled trial. This prospective trial aimed to compare the effectiveness of etoricoxib and acetaminophen in terms of post-operative morphine consumption and pain score in patients undergoing lumbar laminectomy. Forty lumbar-laminectomy patients aged between 18 and 50 years were enrolled, randomized, and allocated into either the etoricoxib group or the acetaminophen group. The measures assessed were the amount of morphine consumed and pain visual analog score (VAS) at 12, 24, and 48 hours after surgery. Adverse events were recorded. Patients in the etoricoxib group had statistically significantly lower morphine consumption than those in the acetaminophen group at 12 hours (P-value = .006), 24 hours (P-value = .006) and 48 hours (P-value = .011). Patients in the etoricoxib group had lower VAS scores than those in the acetaminophen group at 0, 12, 24, 48 hours, the difference being statistically significant at 48 hours (P < .001). Compared to acetaminophen, etoricoxib can significantly reduce post-operative morphine consumption and improve the pain score at 12, 24, and 48 hours.

Gabapentin reduces postoperative pain and opioid consumption in patients who underwent lumbar laminectomy

BackgroundPostoperative pain management solely with opioids elevates the risk of opioid-related adverse events during hospitalization and after discharge from the hospital. Clinical trials have demonstrated gabapentinoids as viable adjunctive treatments for spinal surgeries. However, only a few practice-based studies have examined the efficacy of gabapentin as an opioid-sparing agent for patients undergoing lumbar laminectomy in rural hospital settings. ObjectiveTo determine the effects of gabapentin on opioid consumption and pain perception in patients who underwent lumbar laminectomy at a rural community hospital. MethodsData were collected by retrospective chart reviews of 99 patients who underwent lumbar laminectomy at Yavapai Regional Medical Center from January 1, 2017, to July 1, 2019. The patients were stratified into 2 groups: those who were taking gabapentin as outpatients before surgery and were continued on the same dose postoperatively (n = 50, gabapentin group) and those who were not taking gabapentin preoperatively or postoperatively (n = 49, usual-treatment group). The primary end points were opioid consumption in morphine milligram equivalents (MME) and pain for 24 hours postsurgery. ResultsOutcomes from the mixed-model analysis of variance showed significant main effects of group and time for opioid consumption in MME (F1,97 = 4.3, P < 0.05 and F3,291 = 133.9, P < 0.001, respectively) and numerical pain scale scores (F1,99 = 4.0, P < 0.05 and F3,241 = 21.4, P < 0.001, respectively) and group-time interaction for opioid consumption in MME (F3,291 = 2.6, P = 0.05). Post hoc analyses showed that opioid consumption in MME was significantly lower in the gabapentin group than in the usual-treatment group for the first 6 hours postoperatively. The pain scores were significantly lower in the gabapentin group than in the usual-treatment group across all time periods. ConclusionPatients on gabapentin showed reductions in pain perception and postoperative opioid consumption. The results extend the findings from randomized trials to a real-world clinical setting. These data support using gabapentin in conjunction with opioids for pain management of patients undergoing lumbar laminectomy.

Comparison the effect of bupivacaine plus magnesium sulfate with ropivacaine plus magnesium sulfate infiltration on postoperative pain in patients undergoing lumbar laminectomy with general anesthesia

Purpose In this study, we investigated the effect of local injection of ropivacaine and bupivacaine with magnesium sulfate on postoperative pain in vertebral laminectomy surgery. Design This randomized double-blind prospective study was conducted among 60 patients aged 18–65 years old with ASA class I and II. Methods Group RM: (30 people) received 70 mg ropivacaine (14 ml) plus 1 ml magnesium sulfate (500 mg) volume up to 20 ml with normal saline. Group BM: (30 people) received 70 mg bupivacaine (14 ml) plus 1 ml magnesium sulfate (500 mg) volume up to 20 ml with normal saline. The results were analyzed by SPSS 23 software, and statistical analysis consisted of χ 2 test and t-test, and a p value less than .05 was considered significant. Findings Mean pain score based on VAS in 6 and 12 h after surgery in the RM group was lower in the BM group (p < 0.05). The analgesic request frequency in the RM group was lower than the BM group (p = 0.01). The mean morphine consumption in the RM group was 185 mg and in the BM group was 220 mg. According to the T-test, there was a significant difference between the two groups (p = 0.03). there was no significant difference between the mean arterial blood pressure and mean heart rate between the two groups at 6, 12, 24 and 24 h after surgery (p > 0.05). Conclusion This study showed that wound infiltration with ropivacaine and magnesium sulfate compared to bupivacaine and magnesium sulfate provided better postoperative analgesia and significantly reduced postoperative opioid consumption in patients undergoing lumbar laminectomy.

The Opioid Epidemic in Neurosurgery

Postoperative pain management solely with opioids elevates the risk of opioid-related adverse events during hospitalization and after discharge from the hospital. Clinical trials have demonstrated gabapentinoids as viable adjunctive treatments for spinal surgeries. However, only a few practice-based studies have examined the efficacy of gabapentin as an opioid-sparing agent for patients undergoing lumbar laminectomy in rural hospital settings.To determine the effects of gabapentin on opioid consumption and pain perception in patients who underwent lumbar laminectomy at a rural community hospital.Data were collected by retrospective chart reviews of 99 patients who underwent lumbar laminectomy at Yavapai Regional Medical Center from January 1, 2017, to July 1, 2019. The patients were stratified into 2 groups: those who were taking gabapentin as outpatients before surgery and were continued on the same dose postoperatively (n = 50, gabapentin group) and those who were not taking gabapentin preoperatively or postoperatively (n = 49, usual-treatment group). The primary end points were opioid consumption in morphine milligram equivalents (MME) and pain for 24 hours postsurgery.Outcomes from the mixed-model analysis of variance showed significant main effects of group and time for opioid consumption in MME (F1,97 = 4.3, P < 0.05 and F3,291 = 133.9, P < 0.001, respectively) and numerical pain scale scores (F1,99 = 4.0, P < 0.05 and F3,241 = 21.4, P < 0.001, respectively) and group-time interaction for opioid consumption in MME (F3,291 = 2.6, P = 0.05). Post hoc analyses showed that opioid consumption in MME was significantly lower in the gabapentin group than in the usual-treatment group for the first 6 hours postoperatively. The pain scores were significantly lower in the gabapentin group than in the usual-treatment group across all time periods.Patients on gabapentin showed reductions in pain perception and postoperative opioid consumption. The results extend the findings from randomized trials to a real-world clinical setting. These data support using gabapentin in conjunction with opioids for pain management of patients undergoing lumbar laminectomy.

COMPARATIVE EVALUATION OF ENDOSCOPIC DISCECTOMY AND LUMBAR LAMINECTOMY IN LUMBAR DISC DISEASES

Lumbar disc disease accounts for a large amount of lost productivity in the workforce. Accurate diagnosis can be difficult and often requires interpretation. Treatment is controversial. Treatment failures are not uncommon, are often related to posttraumatic or work-related injuries, and may result in litigation.&#x0D; The present study was planned in Department of Neurosurgery, SKMCH, Muzaffarpur, Bihar, India. In the present study 50 Patients Suffered from Lumbar disc diseases were enrolled and divided based different surgery procedure. In the present study 25 cases of the patients undergoing Endoscopic Discectomy and 25 cases of patients undergoing Lumbar Laminectomy surgery were enrolled.&#x0D; The experience gained from the patients operated upon for lumbar disc herniation by endoscopic technique and conventional laminectomy with discectomy in the present study was presented herewith. All patients had virgin lumbar radiculopathy with positive clinical findings and MRI evidence of herniation. The endoscopic approach meant a shorter operating time, less bleeding during surgery, immediate mobilization of patients and shorter post-operative stay in the hospital and return to work in 7 days which is less than half the usual time in laminectomy with discectomy. In endoscopic technique fewer incidence of wound infections, Catheterization in endoscopic while urinary infection along with catheterization was very low. No patients developed pulmonary embolism, deep vein thrombosis, and increase in neurological deficit or nerve root injury. Thus endoscopic approach to discectomy for herniated lumbar disc remains the procedure of choice for majority of patients requiring surgery and it continues to be the Gold standard against which all procedures must be measured.&#x0D; Keywords: Endoscopic Discectomy, Lumbar Laminectomy, Lumbar disc diseases, etc.

Implementation of magnesium sulphate as an adjunct to multimodal analgesic approach for perioperative pain control in lumbar laminectomy surgery: A randomized placebo-controlled clinical trial

ObjectiveTo investigate the effect of systemic intraoperative administration of magnesium sulphate when used in the context of a multimodal pain management plan on analgesics consumption and pain scores, and perioperative outcomes after lumbar laminectomy surgery. MethodsSeventy-four patients undergoing lumbar laminectomy were enrolled in this randomized, double-blind, placebo-controlled trial. Participants were randomly allocated to receive magnesium (20 mg/kg iv given as bolus before anesthesia induction followed by 20 mg/kg/h civ until surgery completion) or saline. Hemodynamic variables and desflurane consumption were noted at predefined time-intervals intraoperatively. Primary outcome was postoperative cumulative analgesic consumption over 24 h, while pain intensity (assessed by Visual Analogue Scale [VAS] at 1, 2, 4, 6 and 24 h), intraoperative hemodynamics and opioid requirements, recovery profile, time to first analgesic request, and adverse effects constituted secondary end-points. ResultsDemographics, surgery duration, desflurane requirements, and recovery profile were comparable between groups. Magnesium attenuated hemodynamic response during incision and emergence from anesthesia. Postoperative analgesics consumption in morphine iv equivalents (mean difference −9.24 [95 %CI −13.31, −5.17] mg; p = 0.001) and VAS scores at all-time points of assessment were lower in magnesium group; this effect peaked at 4 h (mean difference −2.15 [95 %CI −3.21,−1.09; p = 0.001]. Magnesium reduced intraoperative remifentanil consumption and prolonged the time-interval to first rescue analgesia (p < 0.01). No notable adverse effects were recorded. ConclusionIt occurs that magnesium infusion during lumbar laminectomy surgery potentiates perioperative analgesia and reduces analgesic requirements up to 24 h postoperatively. No profound adverse effect on either intraoperative hemodynamics or any other clinically relevant endpoints becomes evident.

The Effect of Ultra-low-dose Intrathecal Naloxone on Pain Intensity After Lumbar Laminectomy With Spinal Fusion: A Randomized Controlled Trial.

Despite advances in pain management, several patients continue to experience severe acute pain after lumbar spine surgery. The aim of this study was to assess the safety and effectiveness of single ultra-low-dose intrathecal (IT) naloxone in combination with IT morphine for reducing pain intensity, pruritus, nausea, and vomiting in patients undergoing lumbar laminectomy with spinal fusion. In this double-blind trial, patients scheduled for lumbar laminectomy with spinal fusion were randomly assigned to receive single ultra-low-dose IT naloxone (20 μg) and IT morphine (0.2 mg) (group M+N) or IT morphine (0.2 mg) alone (group M). The severity of postoperative pain, pruritus and nausea, and frequency of vomiting were assessed at recovery from anesthesia and, subsequently, at 1, 3, 6, 12, and 24 hours postoperatively using an 11-point (0-10) visual analogue scale. A total of 77 patients completed the study, and there were significant differences in postoperative pain, pruritus, and nausea visual analogue scale between the groups (P<0.05). After adjusting for body mass index and surgery duration, IT naloxone administration reduced the pain score (coefficient=1.84; 95% confidence interval [CI], 1.05-2.63; P<0.001), and the scores of pruritus and nausea (coefficient=0.9; 95% CI, 0.44-1.37; P<0.001 and coefficient=0.71; 95% CI, 0.12-1.31; P=0.02, respectively) compared with IT morphine alone. No serious adverse effects were observed. The addition of ultra-low-dose IT naloxone to IT morphine provides excellent postoperative pain management and effectively controls pruritus and nausea in patients undergoing laminectomy with spinal fusion.

P71. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases?

P71. Is academic department teaching status associated with adverse outcomes after lumbar laminectomy and discectomy for degenerative spine diseases?

Open facet joint denervation as an adjunct in patients undergoing posterior lumbar decompression for spinal stenosis-a single blinded randomized controlled trial.

Facet radiofrequency denervation is a prevalent procedure used to try and relieve back pain. Despite the increasing use of this treatment, its effectiveness has been questioned. In consideration of the conflicting reports in the literature, we sought to conduct a trial to study the short-term effect of facet denervation in patients undergoing lumbar laminectomy(s) to determine the short-term effect of adding facet denervation to patients undergoing lumbar laminectomy(s) where the anatomy was exposed, allowing an open technique to be used for the denervation. Sixty patients with a diagnosis of degenerative lumbar spinal stenosis who complained of neurogenic claudication and back pain for at least 3 months were randomized to undergo a lumbar laminectomy(s) either with or without facet joint denervation. Pain and self-reported function using a 10 cm visual analogue scale (VAS) and the Roland-Morris Disability Questionnaire (RMDQ) were measured before surgery and at patients' 6-, 12- and 24-week follow-up clinic visit. Various parametric and non-parametric tests including the Chi-square, independent samples t-tests, the Mann Whitney U, Wilcoxon sign ranks, one-way ANOVA with a Bonferroni post hoc test were used to analyze the data. The RMDQ scores were analyzed between groups and within groups over time. No differences in pain or functional ability were seen between groups. Both groups significantly improved in both pain and function from baseline to follow up times. Our findings do not support the addition of facet denervation for short-term treatment of back pain in patients undergoing lumbar laminectomy(s) for spinal stenosis within our study design.

Wednesday, September 26, 2018 7:35 AM–9:00 AM ePosters: P8. Is the assessment of the sagittal vertical axis in patients with lumbar spinal stenosis possible using motion analysis system?

BACKGROUND CONTEXT Sagittal balance is frequently evaluated in preoperative planning in spinal surgery by using a measure called “sagittal vertical axis” (SVA) during full body bi-planar low dose radiography (EOS). This radiographic measurement has been correlated with various clinical parameters, particularly in vertebral deformations. However, this measure is radiographic, then only established in static position, whereas it would be particularly interesting to quantify it during dynamic tasks. 3D motion analysis would allow this measure by using external cutaneous markers located on body landmarks close to those used during EOS procedure. PURPOSE The aim of this study is to validate the indirect computation of SVA during 3D motion analysis against the gold standard EOS–SVA. STUDY DESIGN/SETTING Mononcentric open-labeled study. PATIENT SAMPLE Patients undergoing lumbar laminectomy and without other neurological or orthopedic deficit were enrolled in this study. OUTCOME MEASURES Radiographic EOS measurement of SVA. 3D postural motion analysis. METHODS A total of 15days before surgery, patients had a full body EOS where the reference SVA was calculated. Then the patient underwent a postural 3D motion analysis recorded using 8 optoelectronics camera at a 100 Hz frequency. Reflective markers were positioned following validated conventional gait model procedure. Patients performed a balance test of 52.6 seconds in the same position as EOS examination and in standard postural position. Two distances were computed: in sagittal plane, the distance between markers on the 7th cervical vertebrae and the middle of posterior superior iliac spines were computed and further called “C7_PSI” and in sagittal plane, the distance between markers on the auditory canals and the middle of posterior superior iliac spines were computed and further called “EAR_PSI.” Multiple linear regressions were performed with EOS–SVA as variable to explain and C7_PSI or EAR_PSI as explicative variables both adjusted on BMI and age. RESULTS A total of 20 patients were included in the study with a mean age of 70.7±7.8years and BMI of 29.4±3.6. The EOS–SVA was 58.4±58.9 mm (range: –18 to 226 mm). Multiple linear regression have shown good significant fit for C7_PSI in both postural positions (R²=0.78 in EOS position and R²=0.7373 in standard position). The significant model included C7_PSI distance, BMI and age during EOS postural position was 1.88*age–2.61*BMI+0.815*C7_PSI. EAR_PSI distance did not show sufficient level of fit to be considered as good. CONCLUSIONS 3D motion analysis seems to be a promising tool to indirectly assess the SVA. Consequently, we propose a model that might be used to quantify SVA during dynamics tasks like reaching, walking and other functional tests. This method might also be used more frequently for the evaluation of patients and potentially to quantify the effect of surgery. Nonetheless, the model proposed need to be confirmed and externally validated in further studies.

Study of Efficacy of the Use of Peri-Operative Pregabalin and Dexamethasone on Post-Operative Pain in Patients undergoing Lumbar Laminectomy

Objective: This study aimed at studying the efficacy of the peri-operative use of pregabalin and dexamethasone for post-operative pain relief in patients undergoing lumbar laminectomy. Methods: It is a prospective randomized controlled study. The patients on whom the study had been carried out fulfilled the following criteria: Age: above 20 years till 60 years, Gender: both females and males, ASA I and II, Patients scheduled to undergo elective lumbar laminectomy without fusion, patients had been randomly categorized into 2 equal groups by closed envelope technique, 30 in each group. Group P: Pregabalin + Placebo: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Group PD: Pregabalin + Dexamethasone: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Patients received 16 mg dexamethasone intravenously with induction of anesthesia. Results: There was a significant difference about the heart rate intra operative and the mean arterial blood pressure intraoperative and postoperatively at different intervals. As regarding the ETCO2 group P had a higher average at baseline. Group PD had a significant lower consumption of pethidine in comparison with group P. However, there was no significant difference observed in the consumption of ketorolac between the two groups. In comparison between the two studied groups, the overall mean satisfaction score was significantly higher among group PD than among group P.

Study of Efficacy of the Use of Peri-Operative Pregabalin and Dexamethasone on Post-Operative Pain in Patients undergoing Lumbar Laminectomy

Objective: This study aimed at studying the efficacy of the peri-operative use of pregabalin and dexamethasone for post-operative pain relief in patients undergoing lumbar laminectomy. Methods: It is a prospective randomized controlled study. The patients on whom the study had been carried out fulfilled the following criteria: Age: above 20 years till 60 years, Gender: both females and males, ASA I and II, Patients scheduled to undergo elective lumbar laminectomy without fusion, patients had been randomly categorized into 2 equal groups by closed envelope technique, 30 in each group. Group P: Pregabalin + Placebo: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Group PD: Pregabalin + Dexamethasone: Patients had been orally given single dose of 150 mg of pregabalin dissolved in 10 ml distilled water one hour before the initiation of anesthesia and until the second post-operative day, the doses had been given every 12 hours for a total of 4 doses. Patients received 16 mg dexamethasone intravenously with induction of anesthesia. Results: There was a significant difference about the heart rate intra operative and the mean arterial blood pressure intraoperative and postoperatively at different intervals. As regarding the ETCO2 group P had a higher average at baseline. Group PD had a significant lower consumption of pethidine in comparison with group P. However, there was no significant difference observed in the consumption of ketorolac between the two groups. In comparison between the two studied groups, the overall mean satisfaction score was significantly higher among group PD than among group P.

Prospective Randomized Comparative Study to Evaluate Epidural Fibrosis and Surgical Outcome in Patients Undergoing Lumbar Laminectomy with Epidural Autologous Free Fat Graft or Gelfoam: A Preliminary Study.

Introduction:Epidural fibrosis (EF) contributes to unsatisfactory relief of symptoms and failed back syndrome after spine surgery. EF around the nerve root can be more refractory to treatment than the original disc herniation itself. Reoperation on the scar can produce more scarring. Few studies have been conducted regarding the type of material to be used for decreasing EF.Materials and Methods:The prospective randomized comparative study was conducted in the Department of Neurosurgery and Radiodiagnosis, of a tertiary care hospital. Informed and written consent was obtained. Patients previously unoperated with symptoms and radiological features of lumbar spinal canal stenosis were included in the study. Fifteen patients were assigned to Group A (free fat graft) and 15 patients in Group B (Gelfoam group). Postoperatively, at 3 and 6 months, clinical outcome was evaluated and EF was assessed on CE-MRI.Results:Age and sex were comparable in both groups. The pain relief at 3 and 6 months was more in Group A as compared to Group B. In Group A, on CEMRI at 3 months, 87% of patients had none to mild fibrosis, with none had extensive fibrosis. The CEMRI at 6 months showed no increase in fibrosis. In Group B, 80% of patients had none to mild fibrosis at the end of 3 months. At 6 months, 13.3% patients had extensive fibrosis. The extent of EF was found to be statistically significant at 6 months postsurgery.Conclusion:Use of free fat graft at laminectomy site helps in reducing EF.

Effect of Pregabalin on Preoperative Anxiety and Postoperative Pain in Spine Surgery: A Randomized Controlled Study

Abstract Background Pregabalin is a gabapentinoid which has been shown to possess analgesic and anxiolytic properties. The present study aimed to assess the efficacy of a single dose of pregabalin on postoperative pain and preoperative anxiety in patients undergoing lumbar spine surgery. Materials and Methods Sixty adults posted for elective lumbar laminectomy and discectomy were randomly assigned to one of the three groups; Group C received placebo capsules, Group PI received pregabalin 150 mg, and Group P2 received pregabalin 300 mg capsules, 2 h prior to induction of anesthesia. The levels of anxiety and pain were assessed with respective 100 mm visual analog scale (VAS) score. Postoperative fentanyl consumption and occurrence of side effects were recorded. All patients were observed for 8 h, postoperatively. Results There was a significant reduction in preoperative anxiety in both pregabalin groups as compared to control group (p = 0.001). VAS score for pain (at rest and during movement) was significantly decreased at all time intervals in both PI and P2 groups as compared to control (p &lt; 0.05). Fentanyl consumption in the postoperative period was significantly reduced in pregabalin groups as compared to control (p = 0.001). The level of sedation was higher in P2 group in the first 4 h (p &lt; 0.05). The occurrence of postoperative nausea and vomiting was more in control group as compared to the pregabalin groups (p = 0.018). The incidence of dizziness and blurring of vision was significantly more in P2 group. Conclusion Single preoperative dose of pregabalin 150 or 300 mg was effective in reducing preoperative anxiety, postoperative pain and total fentanyl consumption in patients undergoing lumbar laminectomy and discectomy. However, the incidence of postoperative side effects such as sedation, dizziness and visual blurring was more in patients who received pregabalin 300 mg.

Effect of epidural levobupivacaine with or without dexamethasone soaked in gelfoam for postoperative analgesia after lumbar laminectomy: A double blind, randomised, controlled trial

Background and Aims:Postoperative pain results in prolonged hospital stay and delayed return to normal activity. This study was conducted with the aim of evaluating the analgesic efficacy of gelfoam soaked in levobupivacaine with or without dexamethasone placed in the epidural space in patients undergoing lumbar laminectomy.Methods:Ninety adult patients were randomised into three groups. Gelfoam was soaked in 12 mL of 0.9% sodium chloride in Group P, 10 mL of 0.25% levobupivacaine + 2 mL of 0.9% sodium chloride in Group L, and 10 mL of 0.25% levobupivacaine + 2 mL of dexamethasone in group LD. The primary outcome was time to first request for rescue analgesia. Total 24-h tramadol consumption, and postoperative visual analog scale (VAS) scores were recorded. Chi-square test and analysis of variance test were used, and P < 0.05 was considered significant.Results:75 patients completed the study. Time to first rescue analgesia was longer in group LD [10.11 ± 3.10 h] compared with group L [6.48 ± 2.36 h] and group P [1.76 ± 1.13 h]. Total 24-h tramadol consumption was lower in group LD (88 ± 66.58 mg) and group L (120 ± 70.7 mg) compared with group P (280 ± 64.5 mg). Postoperative VAS scores were lower in group LD and group L compared with group P, both at rest and on movement.Conclusion:Epidural gelfoam soaked in levobupivacaine and dexamethasone prolongs the duration of analgesia and decreases rescue analgesic consumption and VAS score postoperatively, in patients undergoing lumbar laminectomy.

Presence of Modic type 1 change increases risk of postoperative pyogenic discitis following decompression surgery for lumbar canal stenosis.

Multicenter retrospective study. Postoperative surgical site infection is one of the most serious complications following spine surgery. Previous studies do not appear to have investigated pyogenic discitis following lumbar laminectomy without discectomy. This study aimed to identify risk factors for postoperative pyogenic discitis following lumbar decompression surgery. We examined data from 2721 patients undergoing lumbar laminectomy without discectomy in five hospitals from April 2007 to March 2012. Patients who developed postoperative discitis following laminectomy (Group D) and a 4:1 matched cohort (Group C) were included. Fisher's exact test was used to determine risk factors, with values of p<0.05 considered statistically significant. The cumulative incidence of postoperative discitis was 0.29% (8/2721 patients). All patients in Group D were male, with a mean age of 71.6±7.2 years. Postoperative discitis was at L1/2 in 1 patient, at L3/4 in 3 patients, and at L4/5 in 4 patients. Except for 1 patient with discitis at L1/2, every patient developed discitis at the level of decompression. The associated pathogens were methicillin-resistant Staphylococcus aureus (n=3, 37.5%), methicillin-susceptible Staphylococcus epidermidis (n=1, 12.5%), methicillin-sensitive S.aureus (n=1, 12.5%), and unknown (n=3, 37.5%). In the analysis of risk factors for postoperative discitis, Group D showed a significantly lower ratio of patients who underwent surgery in the winter and a significantly higher ratio of patients who had Modic type 1 in the lumbar vertebrae compared to Group C. Although further prospective studies, in which other preoperative modalities are used for the evaluation, is needed, our data suggest the presence of Modic type 1 as a risk factor for discitis following laminectomy. Latent pyogenic discitis should be carefully ruled out in patients with Modic type 1. If lumbar laminectomy is performed for such patients, more careful observation is necessary to prevent the development of postoperative discitis.

Comparative Induction of Controlled Hypotension by Electroacupuncture at DU20 Acupoint and Remifentanil in Lumbar Laminectomy

Hypotensive anesthesia is utilized to reduce bleeding during orthopedic surgery. One of the various drugs that have been used to reduce blood pressure is remifentanil. This study was an attempt to compare the effect of remifentanil with that of electroacupuncture (EA) at DU20 on reducing blood pressure. In this randomized controlled clinical trial, 54 patients undergoing lumbar laminectomy were allocated to two groups. Hypotensive anesthesia was performed through infusion of remifentanil 100 μg/kg/min for the control group, and EA at DU20 acupoint with a frequency of 2-10 Hz and intensity of 1-5 mA for the intervention group. Blood pressure, pulse rate, volume of blood lost and the quality of surgical field were evaluated every 10 min. There were no statistically significant differences between the two groups in terms of the changes in mean arterial pressure (MAP), pulse rate, and the quality of surgical field (P > 0.05). Therefore, EA can be as effective as remifentanil to reduce blood pressure in the patients undergoing lumbar laminectomy.

Comparison of Bupivacaine Plus Magnesium Sulfate and Ropivacaine Plus Magnesium Sulfate Infiltration for Postoperative Analgesia in Patients Undergoing Lumbar Laminectomy: A Randomized Double-blinded Study.

Aim:The objective of this study was to assess and compare the analgesic duration of local infiltration of bupivacaine plus magnesium sulfate and ropivacaine plus magnesium sulfate for postoperative analgesia in patients undergoing lumbar laminectomy.Study Design:A randomized, prospective, double-blinded single hospital, comparative study.Methods:Sixty adult patients of the American Society of Anesthesiologists physical Status I and II were randomly allocated into two Groups BM and RM, comprising 30 and 31 patients. Postlumbar laminectomy, the study drug was locally infiltrated into the paravertebral muscles on either side before skin closure. Group BM was given 20 ml of 0.25% bupivacaine combined with 500 mg of magnesium sulfate (constituted with normal saline [NS]), and Group RM was given 20 ml of 0.25% ropivacaine combined with 500 mg of magnesium sulfate (constituted with NS). Postoperative visual analog scale pain score was assessed hourly for the first 24 h postoperatively. Duration of postoperative analgesia, rescue analgesia consumption and side effects were also recorded.Statistical Analysis:Comparison of data between the groups was done with SPSS 21.0© using independent t-test, Chi-square test, and Mann–Whitney U-test accordingly. P<0.05 was considered statistically significant.Results:Time to first analgesic consumption was significantly longer in Group BM (7.3 ± 0.46 h) compared to Group RM (6.6 ± 0.69 h) (P < 0.05). The consumption of nalbuphine rescue analgesic was significantly higher in Group RM (15.33 ± 5.07 mg) compared to Group BM (12 ± 4.07 mg) (P < 0.05).Conclusion:Wound infiltration with bupivacaine and magnesium sulfate compared to ropivacaine and magnesium sulfate provided longer duration of postoperative analgesia and significantly reduced postoperative opioid consumption in patients undergoing lumbar laminectomy.