Faculty Collaboration Database

Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine. Spine (Phila Pa 1976) 2001 Mar 15;26(6):658-61

Date

03/14/2001

Pubmed ID

11246381

DOI

10.1097/00007632-200103150-00021

Scopus ID

2-s2.0-0035868822 (requires institutional sign-in at Scopus site)   47 Citations

Abstract

STUDY DESIGN: Prospective, randomized, double-blind study.

OBJECTIVE: To assess the efficacy of ketorolac and bupivacaine in reducing postoperative pain after microsurgical lumbar discectomy.

SUMMARY OF BACKGROUND DATA: Microsurgical lumbar discectomy often is performed as an ambulatory procedure. Pain, nausea, and urinary retention may delay discharge. It was hypothesized that intraoperative ketorolac or bupivacaine would reduce postoperative pain as measured by morphine demand.

METHODS: After Institutional Review Board (IRB) approval and informed consent, 30 patients undergoing single-level microsurgical lumbar discectomy under general anesthesia randomly received either intravenous ketorolac, intramuscular bupivacaine, or placebo before wound closure. After surgery, all patients received intravenous, MSO4, patient-controlled analgesia. MSO4 demand was compared between groups at 30 minutes and at 1, 4, 8, 16, 20, and 24 hours after surgery by one-way ANOVA. Pre- and postoperative pain was assessed by using a standard scale and was correlated to postoperative MSO4 demand by Pearson correlation. Significance was assumed at P < 0.05.

RESULTS: There were no group differences in age, gender, weight, disc level, preoperative pain, or preoperative use of pain medication. Neither ketorolac nor bupivacaine decreased pain or nausea scores, MSO4 demand, or time to void and ambulation. Preoperative pain was significantly correlated to postoperative narcotic demand (r = 0.46, P < 0.01). Preoperative narcotic or NSAID use was not correlated to either preoperative pain scores or postoperative MSO4 requirement.

CONCLUSIONS: Neither ketorolac nor bupivacaine decreased the postoperative narcotic requirement in patients undergoing microsurgical lumbar discectomy. Postoperative narcotic requirements are increased in patients who are in severe pain before surgery, regardless of preoperative narcotic use.

Author List

Mack PF, Hass D, Lavyne MH, Snow RB, Lien CA

Author

Cynthia A. Lien MD Chair, Professor in the Anesthesiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Analgesics, Opioid
Anesthetics, Local
Anti-Inflammatory Agents, Non-Steroidal
Bupivacaine
Diskectomy
Drug Interactions
Female
Humans
Intervertebral Disc Displacement
Ketorolac
Lumbar Vertebrae
Male
Microsurgery
Pain Measurement
Pain, Postoperative
Prospective Studies