The perioperative use of corticosteroids and bupivacaine in the management of lumbar disc disease

1993 ◽  
Vol 78 (3) ◽  
pp. 383-387 ◽  
Author(s):  
Ryan S. Glasser ◽  
Robert S. Knego ◽  
Johnny B. Delashaw ◽  
Richard G. Fessler
Keyword(s):  
Hospital Stay ◽  
Nerve Root ◽  
Skin Incision ◽  
Lumbar Discectomy ◽  
Fat Graft ◽  
Control Group ◽  
Lumbar Microdiscectomy ◽  
Anesthetic Agents ◽  
Long Acting ◽  
Group 1

✓ 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 (methylprednisolone 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.

scholarly journals Shrimp diet and skin healing strength in rats

2007 ◽  
Vol 20 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Elizabeth Lage Borges ◽  
Fernanda Kelley Silva Pereira ◽  
Jacqueline Isaura Alvarez-Leite ◽  
Luiz Ronaldo Alberti ◽  
Mônica Alves Neves Diniz Ferreira ◽  
...  
Keyword(s):  
Tensile Strength ◽  
Wistar Rats ◽  
Skin Incision ◽  
Control Group ◽  
Dorsal Skin ◽  
Interrupted Suture ◽  
Male Wistar Rats ◽  
Group 2 ◽  
Skin Healing ◽  
Group 1

OBJECTIVE: Surgical scar tensile strength may be influenced by several factors such as drugs, hormones and diet. The purpose of the present study was to determine the influence of a shrimp-enriched diet on the tensile strength of rat scars. METHODS: Forty male Wistar rats were submitted to a 4 cm dorsal skin incision and the wounds were sutured with 5-0 nylon interrupted suture. The animals were divided into two groups: Group 1 (control) received a regular diet, and Group 2 (experimental) received a shrimp-enriched diet. The two diets contained the same amounts of proteins, lipids and carbohydrates. The rats in each group were divided into two subgroups according to the time of assessment of the scar tensile strength: subgroup A, studied on the 5th postoperative day, and subgroup B, studied on the 21st postoperative day. RESULTS: The tensile strength of the scar on the 5th postoperative day was lower in the animals that received the shrimp-enriched-diet (303.0, standard error of mean= 34.1) than in the control group (460.1, SEM = 56.7) (p<0.05). CONCLUSION: A shrimp diet reduces the tensile strength of the scar. The next step of this study will be to clarify the mechanism in which shrimp affects tensile strength.

Ambulatory Microsurgery for Ruptured Lumbar Discs: Report of Ten Cases

Neurosurgery ◽  
1988 ◽  
Vol 22 (3) ◽  
pp. 523-526 ◽  
Author(s):  
Herbert L. Cares ◽  
Robert S. Steinberg ◽  
Edgar T. Robertson ◽  
Paolo Caldini
Keyword(s):  
Computed Tomography ◽  
Day Surgery ◽  
Skin Incision ◽  
Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Outpatient Program ◽  
Effective Option ◽  
Microsurgical Approach ◽  
Microsurgical Techniques ◽  
Step Down

Abstract Advances in microsurgical techniques combined with a widening interest in same-day surgery led us to investigate ambulatory lumbar discectomy. We could find no precedent in the literature. Ten patients with classic ruptured lumbar discs confirmed by computed tomography chose to participate. They were aged 31 to 51, seven men and three women, in excellent general health. A microsurgical approach through a 25-mm skin incision was performed. The technique emphasized removal of suffiient medial facet to allow excision of the disc with minimal or no root retraction. Once awake in the recovery room, patients were transferred to a separate ambulatory step-down unit. They were discharged only after they had voided, ambulated, taken oral nourishment, and been examined by the surgeon. A visiting nurse checked the patient at home the evening of operation and the next day. All returned to their usual occupation between 3 and 14 days postoperatively. All were satisfied and would choose the outpatient program again. Our experience indicates that ambulatory lumbar microdiscectomy can be a safe, effective option for selected patients. (Neurosurgery 22:523-526, 1988)

scholarly journals Efficacy of intraoperative epidural triamcinolone application in lumbar microdiscectomy: a matched-control study

2018 ◽  
Vol 28 (3) ◽  
pp. 291-299 ◽  
Author(s):  
Martin N. Stienen ◽  
Holger Joswig ◽  
Ivan Chau ◽  
Marian C. Neidert ◽  
David Bellut ◽  
...  
Keyword(s):  
Functional Impairment ◽  
Nerve Root ◽  
Short Form ◽  
Leg Pain ◽  
Control Group ◽  
Lumbar Microdiscectomy ◽  
Objective Functional Impairment ◽  
And Control ◽  
Objective Functional ◽  
Age And Sex

OBJECTIVEThe purpose of this study was to investigate whether the intraoperative application of an epidural steroid (ES) on the decompressed nerve root improves short- and midterm subjective and objective clinical outcomes after lumbar microdiscectomy.METHODSThis study was a retrospective analysis of a 2-center database including consecutive cases in which patients underwent lumbar microdiscectomy. All patients who received ES application (40 mg triamcinolone, ES group) were matched by age and sex to patients who had not received ES application (control group). Objective functional impairment (OFI) was determined using age- and sex-adjusted T-scores of the Timed Up and Go (TUG) test. Back and leg pain (visual analog scale), functional impairment (Oswestry Disability Index [ODI], Roland-Morris Disability Index [RMDI], and health-related quality of life (hrQoL; 12-Item Short Form Health Survey [SF-12] physical component summary [PSC] score and EuroQol [EQ-5D index]) were measured at baseline, on postoperative day 3, and at postoperative week 6.RESULTSFifty-three patients who received ES application were matched with 101 controls. There were no baseline demographic or disease-specific differences between the study groups, and preoperative pain, functional impairment, and hrQoL were similar. On postoperative day 3, the ES group had less disability on the RMDI (mean 7.4 vs 10.3, p = 0.003) and higher hrQoL as determined by the SF-12 PCS (36.5 vs 32.7, p = 0.004). At week 6, the ES group had less disability on the RMDI (3.6 vs 5.7, p = 0.050) and on the ODI by trend (17.0 vs 24.4, p = 0.056); better hrQoL, determined by the SF-12 PCS (44.3 vs 39.9, p = 0.018); and lower OFI (TUG test T-score 100.5 vs 110.2, p = 0.005). The week 6 responder status based on the minimum clinically important difference (MCID) was similar in the ES and control groups for each metric. The rates and severity of complications were similar, with a 3.8% and 4.0% reoperation rate in the ES group and control group, respectively (p = 0.272). There was a tendency for shorter hospitalization in the ES group (5.0 vs 5.8 days, p = 0.066).CONCLUSIONSIntraoperative ES application on the decompressed nerve root is an effective adjunct treatment that may lower subjective and objective functional impairment and increase hrQoL in the short and intermediate term after lumbar microdiscectomy. However, group differences were lower than the commonly accepted MCIDs for each metric, indicating that the effect size of the benefit is limited.■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: retrospective cohort trial; evidence: Class II.

scholarly journals Lumbar Discectomy: A National Survey of Neurosurgeons and Literature Review

2009 ◽  
Vol 36 (2) ◽  
pp. 196-200 ◽  
Author(s):  
Aleksa Cenic ◽  
Edward Kachur
Keyword(s):  
Controlled Trial ◽  
Adult Population ◽  
Skin Incision ◽  
Lumbar Discectomy ◽  
Fat Graft ◽  
Preoperative Imaging ◽  
Management Approach ◽  
Skin Closure ◽  
Chi Square ◽  
Neurosurgical Procedure

Background:To ascertain neurosurgical practices in the surgical management of one-level lumbar discectomies in the Canadian adult population.Methods:One page questionnaire faxed to each Neurosurgeon in Canada with questions relating to their practice in the management of this common neurosurgical procedure. All data analyzed using Chi-square statistics.Results:112 completed surveys were returned hence, giving a 64% response rate with the respondents being predominantly adult neurosurgeons. Of the respondents, 88% perform lumbar discectomy in adults. Only 15% of respondents had a Spine Fellowship. For preoperative imaging, 44% use BOTH CT and MRI whereas 28% use only MRI and 15% use only CT. Prior to initial skin incision, 57% use a localization X-ray image. Preoperative antibiotics are prescribed by 92% of respondents. Majority of respondents (60%) use a pre-incision local anesthetic, whereas only a minority (44%) of respondents employ pre-closure intramuscular injection. With respect to magnification, 70% use microscope, 19% loupes, and 8% neither. Only 12% use minimally invasive tubular retractors. 68% remove “as much disc as possible”, while 31% remove “ONLY herniated part”. In the case of dural tears, 77% of respondents use fibrin glue (Tisseel®). Prior to skin closure, majority of neurosurgeons do NOT use a fat graft (72%), whereas 61% of respondents use epidural steroids. With respect to discharge from the hospital, 58% are discharged on the next day, 18% on the same day, and 23% in two days. Return to work is not recommended until at least six weeks post-op (96%). Most neurosurgeons (93%) would not operate on an individual with a chief complaint of low back pain.Conclusions:Our survey has identified variations in practice patterns amongst Canadian Neurosurgeons with respect to performing one-level lumbar discectomies. This survey is expected to form a basis for the design of a randomized controlled trial in the evaluation of the best management approach for this common neurosurgical procedure.

scholarly journals Comparison of continuous versus interrupted abdominal fascia closure using polydioxanone suture in laparotomy

2019 ◽  
Vol 6 (8) ◽  
pp. 2832
Author(s):  
Avinash Chandra Sharma ◽  
Akhil Kumar Gupta ◽  
Nitin Singh ◽  
Arvind Kumar Maurya ◽  
Mamta Singla
Keyword(s):  
Hospital Stay ◽  
Major Complication ◽  
Fascial Closure ◽  
Control Group ◽  
Group I ◽  
Abdominal Fascia ◽  
Group Ii ◽  
Group 2 ◽  
Fascia Closure ◽  
Group 1

Background: Laparotomy is a major surgical procedure in emergency settings. There is paucity of data regarding abdominal fascia closure in emergency laparotomies in Indian population. This study was planned to compare two techniques of fascial closure namely continuous and interrupted using polydioxanone in patients undergoing midline emergency laparotomies in our institute.Methods: This prospective study was conducted in Surgery Department, MMC&H, Muzaffarnagar, from January 2017 to June 2018. 60 patients undergoing emergency laparotomies were divided into two groups of 30 each. Group I (study group) patients underwent interrupted suture abdominal closure; Group II (control group) patients underwent continuous suture closure.Results: Commonest diagnoses were duodenal and enteric perforations. Mean closure time in Group 1 was 31.6 minutes and in Group 2 -17.3 minutes. Mean hospital stay in Group I and II were 12.88 and13.76 days respectively. 4 Group I patients developed wound discharge versus 6 patients in Group II. Burst abdomen occurred in 3 out of 60 patients. One Group I patient had localised fascial burst. One Group II patient had localized while one had complete fascial burst. One incisional hernia was observed in each group at 3rd month of follow up. Three patients in Group 1 and one in Group 2 developed suture sinus.Conclusions: Major complication is wound dehiscence leading to increased morbidity, hospital stay and cost. In our study, we used continuous and interrupted PDS sutures and found that interrupted suturing method of abdominal wall closure is better, though it takes more time.

scholarly journals Perbedaan Respon Hemodinamik terhadap Penambahan Clonidin 1 dan 2 mcg/kgbb pada Scalp Block untuk Operasi Kraniotomi

2021 ◽  
Vol 10 (3) ◽  
pp. 162-171
Author(s):  
Syarif Afif ◽  
◽  
Tri Ardana Arianto ◽  
Sugeng Budi Santosa
Keyword(s):  
Blood Pressure ◽  
Pulse Rate ◽  
Skin Incision ◽  
Control Group ◽  
Hemodynamic Responses ◽  
Nerve Blocks ◽  
Anesthetic Agents ◽  
Group I ◽  
Significant Difference ◽  
Scalp Block

Bacground and Objective: The addition of a levobupivacaine scalp block is effective in reducing hemodynamic responses such as blood pressure, mean arterial pressure (MAP) and pulse rate, especially when pinning, skin incisions, and durameter incisions in craniotomy. Adjuvants are often added to local anesthetics to enhance and prolong the analgesic effect of peripheral nerve blocks. Clonidine has a synergistic action with local anesthetic agents. Clonidine increases sensory and motor blocks in both peripheral and neuraxial blocks. The common dose is 2 mcg/kgbw. The aim of this study was to determine the effectiveness of adding clonidine 2 mcg/kg and 1 mcg/kg on scalp block as craniotomy analgesic. Subjects and Methods: Study on 30 patients met the inclusion criteria. Subjects were divided into three groups, group I: scalp block with levobupivacain 0.25%, group II: scalp block plus clonidine 1 mcg/kg, group III: scalp block plus clonidine 2mcg/kg. All patients were treated with general anesthesia according to the standard then assessed their blood pressure, MAP, pulse rate before intubation, pinning, skin incision and duramater incision. Results: There was a significant difference in the addition of clonidine with the control group, especially in the pulse and diastolic rates. Clonidine 2 mcg/kg at several times showed a significant difference compared to 1 mcg/kgbb dose. Conclusion: The clonidine addition to scalp block of levobupivacaine was effective in maintening hemodynamic responses, especially pulse rate and diastolic blood pressure.

scholarly journals A prospective randomised clinical trial of prophylactic antibiotic in caesarean delivery and fetomaternal outcome

2018 ◽  
Vol 7 (2) ◽  
pp. 639
Author(s):  
Apurba Mandal ◽  
Shibram Chattopadhyay ◽  
Pragnya Paramita Nayak ◽  
Sudakshina Panja ◽  
Shritanu Bhattacharyya ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Umbilical Cord ◽  
Caesarean Delivery ◽  
Prophylactic Antibiotic ◽  
Skin Incision ◽  
Postoperative Hospital Stay ◽  
Control Group ◽  
Study Group ◽  
Cord Clamping ◽  
Umbilical Cord Clamping

Background: Infectious maternal and perinatal morbidities are 5 to 20 times more in caesarean section when compared to vaginal births. Objective of present study was to assess the rates of maternal and neonatal infectious morbidities following administration of antibiotic before skin incision compared to given after umbilical cord clamping during caesarean delivery.Methods: 185 pregnant women with gestational periods more than 34 weeks who were prepared for caesarean delivery, randomized to single dose antibiotic given either before skin incision (study group) or after umbilical cord clamping (control group). Primary outcome measures: maternal postoperative infections morbidities. Secondary outcome measures: neonatal infections morbidities with Sick Newborn Care Unit (SNCU) admissions and postoperative hospital stay of mother.Results: Surgical Site Infections (SSI) and postoperative fever were significantly less in the study group than the control group so also the lesser incidences of endometritis but no statistically significant difference in the incidence of peritonitis and wound dehiscence were observed in both groups. No significant differences were seen in neonatal infectious morbidities and SNCU admission when compared in both groups. There was significantly less mean postoperative hospital stay of mothers in the group who received prophylactic antibiotic pre-incision.Conclusions: Antibiotic given 30-60 minutes before skin incision significantly decreases maternal postoperative infectious morbidities barring neonate.

MODULATION OF TRIGLYCERIDES IN FEMALE RATTUS RATTUS WITH STEROID CONTRACEPTIVE ALGESTONE ACETOPHENIDE (DHPA)

2019 ◽  
Vol 25 (1) ◽  
Author(s):  
ASHOK KUMAR ◽  
ALPANA PARMAR ◽  
ANAND KUMAR BAJPEYEE
Keyword(s):  
Mixed Type ◽  
Rattus Rattus ◽  
Young Female ◽  
Female Rats ◽  
Control Group ◽  
Black Rat ◽  
Long Acting ◽  
Steroid Contraceptive

Young female Black rat (Rattus rattus), were administered monthly long acting steroid contraceptive to induce hypertriglyceridemia. It was observed that by 3 weeks of the second injection of estrogen containing mixed type of contraceptive, female rats developed consistent and frank hyperglyceridemia . TG in the treated rats was 195.8 ± 7.44 mg /100 ml as compared to 91.5 ± 6.27 mg/100ml in plasma of the control group.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Uncomplicated adult inguinal hernia repair under local anaesthesia and spinal anaesthesia

2020 ◽  
Vol 11 (3) ◽  
pp. 3212-3221
Author(s):  
Naniwadekar R G
Keyword(s):  
Inguinal Hernia ◽  
Hospital Stay ◽  
Spinal Anaesthesia ◽  
Local Anaesthesia ◽  
Control Group ◽  
Early Ambulation ◽  
Inguinal Hernias ◽  
Hernia Inguinal ◽  
The Subject ◽  
Prolonged Hospital

Multiple researchers have given numerous guidelines in the clinical management of this disorder in the late nineteenth and twentieth centuries, after comprehensive works on the subject. As a result, a very wide variety of surgical procedures are now available to the surgeon to suit the requirement. There have been numerous advances in the management of inguinal hernia. Inguinal hernias can conveniently be repaired under all kinds of anaesthesia, namely general, spinal and local. Whereas the general anaesthesia requires the services of an experienced anaesthetist and new devices and spinal anaesthesia requires postoperative impairment while local anaesthesia is safe to prescribe, easy and efficient and does not cause postoperative complications. This work consisted of a study group of twenty-five adult patients of uncomplicated inguinal hernias, who after repair of hernias, which after repair of hernias were allowed early ambulation and had a short hospital, stay of one day post operatively. The second control group consisted of similar twenty-five patients who are subjected to conventional delayed ambulation and prolonged hospital stay. The results of repair in the two groups were compared; the available literature on the subject was reviewed. The implementation of ”shortstay surgery” not only relieves the waiting list in hospitals but also offers an economic boost and provides the patient with some social advantages.

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