Ash Wilson-Smith1, Nicholas Chang1, Victor M Lu2, Ralph J Mobbs3, Matthew Fadhil1, Declan Lloyd2, Sara Kim1, Kevin Phan4. 1. Faculty of Medicine, The University of New South Wales, Sydney, Australia. 2. Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia. 3. Faculty of Medicine, The University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia; Department of Neurosurgery, Prince of Wales Hospital, Randwick, Australia. 4. Faculty of Medicine, The University of New South Wales, Sydney, Australia; NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia; Department of Neurosurgery, Prince of Wales Hospital, Randwick, Australia; Faculty of Medicine, Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: kphan.vc@gmail.com.
Abstract
BACKGROUND: This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time, and use of opioid analgesics postoperatively. METHODS: We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies using epidural steroids through any route after lumbar surgery. The primary study outcomes included preoperative and postoperative pain as assessed with a visual analogue scale (VAS), length of hospital stay (LOS), and postoperative use of opioid analgesics. The data were extracted and stratified according to the steroid administered. Data were then assessed for heterogeneity, subgroup differences, and ultimately tabulated in a Forest plot. RESULTS: A total of 17 randomized controlled trials were included in this review, with 16 undergoing quantitative analysis. Steroids were shown to be superior in terms of VAS outcome at 24 hours, with triamcinolone and dexamethasone performing similarly. Methylprednisolone paradoxically performed worse at the 24-hour mark. At 1 month, all steroids illustrated superiority in terms of VAS outcome. Steroids also proved superior in reducing LOS and postoperative use of opioid analgesia. CONCLUSIONS: Intraoperative or perioperative epidural administration of steroids offers significant benefits in terms of pain control, reduction in LOS, and use of postoperative opioid analgesia. Before steroids are routinely used by spinal surgeons, however, significantly more research is required. A particular emphasis should be placed on quality study protocols and data recording, to allow for more thorough analyses in the future.
BACKGROUND: This review assessed the efficacy of epidural steroid administration on the reduction of pain, hospital stay time, and use of opioid analgesics postoperatively. METHODS: We searched Medline, PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews for studies using epidural steroids through any route after lumbar surgery. The primary study outcomes included preoperative and postoperative pain as assessed with a visual analogue scale (VAS), length of hospital stay (LOS), and postoperative use of opioid analgesics. The data were extracted and stratified according to the steroid administered. Data were then assessed for heterogeneity, subgroup differences, and ultimately tabulated in a Forest plot. RESULTS: A total of 17 randomized controlled trials were included in this review, with 16 undergoing quantitative analysis. Steroids were shown to be superior in terms of VAS outcome at 24 hours, with triamcinolone and dexamethasone performing similarly. Methylprednisolone paradoxically performed worse at the 24-hour mark. At 1 month, all steroids illustrated superiority in terms of VAS outcome. Steroids also proved superior in reducing LOS and postoperative use of opioid analgesia. CONCLUSIONS: Intraoperative or perioperative epidural administration of steroids offers significant benefits in terms of pain control, reduction in LOS, and use of postoperative opioid analgesia. Before steroids are routinely used by spinal surgeons, however, significantly more research is required. A particular emphasis should be placed on quality study protocols and data recording, to allow for more thorough analyses in the future.
Authors: Sem M M Hermans; Aniek A G Lantinga-Zee; Kim Rijkers; Henk van Santbrink; Wouter L W van Hemert; Mattheus K Reinders; Daisy M N Hoofwijk; Sander M J van Kuijk; Inez Curfs Journal: Brain Spine Date: 2021-11-12