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Postoperative lumbar microdiscectomy pain. Minimalization by irrigation and cooling
K N Fountas1, E Z Kapsalaki, K W Johnston
1Department of Neurological Surgery, Medical Center of Central Georgia, Macon, USA.
Study Design:
Seventy patients undergoing de novo lumbar microdiscectomy were prospectively randomized into a control group and a group in which cold intraoperative wound irrigation along with postoperative wound cooling was used. Postoperative analgesia requirements and length of hospital stay were analyzed and correlated.
Objectives:
To evaluate the role of intraoperative cold irrigation and postsurgical cooling in minimizing postoperative lumbar discectomy pain.
Summary Of Background Data:
Regulated hypothermia has been used frequently in pain reduction; however, the efficacy of such a strategy in lumbar disc procedures has not been established.
Methods:
Seventy patients (43 men and 27 women), operated on the first time for lumbar disk herniation were prospectively randomized into two groups. A standard microdiscectomy was performed on all patients. In cohort A the wound site was irrigated with a cold (18 C) 5% bacitracin solution for 5 minutes. Additionally, a cooling microtemperature pump was placed on the wound site for 24 hours after surgery. The patients in the control group (cohort B) were treated in a standard fashion without additional hypothermic therapy. All patients received postoperative analgesia through a self-administered morphine pump. The amount of postoperative analgesia received was calculated in morphine equivalents per kilogram. The length of hospital stay was also noted.
Results:
The total amount of pain medication was significantly smaller in cohort A than in the control group (cohort B). For the statistical analysis of the results, covariate analyses for both the length of hospital stay and the morphine dose were used, demonstrating a statistically significant difference with P = 0.0001. No postoperative wound infection was noted in either group.
Conclusions:
Intraoperative and postoperative wound site cooling is a safe, inexpensive, and efficient therapeutic method. It reduces the patients' postoperative pain, promotes earlier ambulation and decreases the length of hospital stay.
