Pf. Mack et al., Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine, SPINE, 26(6), 2001, pp. 658-661
Study Design. Prospective, randomized, double-blind study. Objective. To as
sess the efficacy of ketorolac and bupivacaine in reducing postoperative pa
in after microsurgical lumbar discectomy.
Summary of Background Data. Microsurgical lumbar discectomy often is perfor
med as an ambulatory procedure. Pain, nausea, and urinary retention may del
ay discharge. It was hypothesized that intraoperative ketorolac or bupivaca
ine would reduce postoperative pain as measured by morphine demand.
Methods. After Institutional Review Board (IRB) approval and informed conse
nt, 30 patients undergoing single-level microsurgical lumbar discectomy und
er general anesthesia randomly received either intravenous ketorolac, intra
muscular bupivacaine, or placebo before wound closure. After surgery, all p
atients received intravenous, MSG,, patient-controlled analgesia. MSG, dema
nd 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 asses
sed by using a standard scale and was correlated to postoperative MSG, dema
nd 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 ketoro
lac nor bupivacaine decreased pain or nausea scores, MSG, demand, or time t
o void and ambulation. Preoperative pain was significantly correlated to po
stoperative narcotic demand (r = 0.46, P < 0.01). Preoperative narcotic or
NSAID use was not correlated to either preoperative pain scores or postoper
ative MSG, 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.