Postoperative narcotic requirement after microscopic lumbar discectomy is not affected by intraoperative ketorolac or bupivacaine

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.