Clinical Notes – Long-Lasting Beneficial Effects Of Periradicular Injection Of Meloxicam For Treating Chronic Low Back Pain And Sciatica.

By London Spine
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Clinical Notes – Long-Lasting Beneficial Effects Of Periradicular Injection Of Meloxicam For Treating Chronic Low Back Pain And Sciatica.

Minerva Anestesiol. 2013 Jan 10;

Authors: Borghi B, Aurini L, White PF, Mordenti A, Lolli F, Borghi R, Martignani M

Abstract
BACKGROUND: Chronic low back pain (LBP) and sciatica can occur without obvious structural causes and is often resistant to conventional analgesic drugs. The effect of periradicular injection of meloxicam on LBP with or without a radicular component was assessed. A secondary objective of this prospective observational study was to assess the effect of meloxicam on functional recovery. METHODS: 72 patients (30 men, 42 women) with LBP and/or sciatica were followed for 90 days to 6 years after injecting 10 mg meloxicam in 10 ml saline at each of the involved dermatomal levels. A standard verbal rating scale (VRS) from 0= no pain to 10= severe pain was used for assessing LBP before the injection of meloxicam (at baseline) and at 1, 5, 10, 30 and 60 min, and 1, 5, 15, 30 and 90 days intervals after the injection. The meloxicam injection was repeated only if the VRS score remained > 3. Rescue analgesic requirements and functional activity levels were also assessed from 30-90 days after the last injection of meloxicam. RESULTS: The mean baseline LBP score was 8.60±1.50 (SD) despite the use of multi-modal analgesic regimens (NSAIDs, glucocorticosteroids, paracetamol, oral opioids, gabapentanoid compounds, epidural or periradicular steroid and/or local anesthetics) as well as laser treatments and physical therapy. The majority of patients reported that their pain intensity decreased by ~50% 1-2 min after the meloxicam injection was completed. Thirty-six patients (50%) required no further injections, 25 patients (35%) required a second injection after 7 days, and 11 patients (15%) required a total of 3 injections. After the meloxicam treatment(s), only 10 patients (14%) required “rescue” analgesia with oral NSAIDs. All patients were able to increase their level of functional activity after the meloxican treatment(s). CONCLUSIONS: Periradicular injections of meloxicam (10 mg) appear to be a useful alternative to opioid and nonopiod analgesics for patients with intractable LBP due to nerve root inflammation.

PMID: 23306395 [PubMed – as supplied by publisher]

Intra- versus postoperative initiation of pain control via a thoracic epidural catheter for lumbar spinal fusion surgery: a randomised trial.

By London Spine

Intra- versus postoperative initiation of pain control via a thoracic epidural catheter for lumbar spinal fusion surgery: a randomised trial.

Minerva Anestesiol. 2017 Oct 04;:

Authors: Wenk M, Liljenqvist U, Kaulingfrecks T, Gurlit S, Ermert T, Pöpping DM, Möllmann M

Abstract
BACKGROUND: Thoracic epidural anesthesia (TEC) is one of the pillars of preoperative pain care. Particularly for spine surgery which causes significant postoperative pain TEC seems like an appealing option. However, beneficial effects of a TEC are questionable when the catheter is not used intraoperatively, a decision that is usually based on the surgeon’s wish to perform immediate neurological examination postoperatively.
METHODS: 40 patients undergoing transforaminal lumbar interbody fusion surgery (TLIF) were randomized in two groups. Patients received pre-operative insertion of a TEC. For patients in the intraop group an epidural infusion was started preoperatively and maintained throughout. For patients in the postop group the epidural infusion was started once neurological examination had been performed. The primary outcome measure in this study was postoperative requirements of piritramide during the first two postoperative hours. Secondary outcomes involved postoperative pain numeric rating scale (NRS) scores, intraoperative opioid requirements, side effects and ability to perform direct postoperative neurological examination.
RESULTS: Postop group patients required significantly more opioids both intra- and postoperatively (p=0.036 and p=0.039) and NRS scores were significantly higher on admission to recovery, at 30 and 60 min as compared to patients in the intraop group (p=0,013; p=0.004 and p=0.012). Early postoperative neurological examination was feasible in all patients in both groups.
CONCLUSIONS: Epidural catheters used intraoperatively during TLIF are feasible, significantly reduce pain, intra- and postoperative use of opioids and do not influence the quality of neurological tests directly after the surgical procedure.

PMID: 28984097 [PubMed – as supplied by publisher]

Osteoporotic vertebral compression fracture pain (back pain): our experience with balloon kyphoplasty

By London Spine

AIM: The aim of this study is to evaluate the safety and effectiveness of antalgic and functional results after interdisciplinary approach and treatment of vertebral compression fractures (VCF) with percutaneous balloon kyphoplasty (KP) by the pain medicine specialist. METHODS: Between April and December 2004, after informed consent, 13 patients have been treated for a total amount of 15 KP. For L5 – T11 level spinal anesthesia was performed, above T11 local infiltration was used. The following parameters were recorded: intraoperative course, postoperative course, pain before and after treatment, vertebral height restoring and quality of life measuring on visual analogical scale (VAS) and quality of life questionnaire of the European Foundation for Osteoporosis (QUALEFFO) scale. RESULTS: No complications or adverse events were recorded. VAS values for pain were 6.2+/-2.1 preKP vs 3.3+/-1.7 and 4.5+/-1.1 respectively postKP and at follow-up, with statistically significant differences. Vertebral heights were 53.5+/-16%, 71.2+/-21% and 68.1+/-13.5%, preKP, postKP and at follow-up respectively, with statistically significant differences, similarly to quality of life related parameters and QUALEFFO score. CONCLUSION: Back pain due to vertebral compression fractures is a quite frequent diagnosis for the pain medicine specialist; KP is a new technique showing an association of a low incidence of complications with a success rate, both on pain control and on vertebral height restoring. In our study, KP proved to be a safe technique with a high success rate, both for pain relief and for vertebral height restoring, with immediate results and important consequences on the patient’s quality of life, physical and mental status, with a low incidence of complications due also to the choice of performing this procedure in locoregional anesthesia