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Pain Control After Lumbar Microdiscectomy

Back pain from a degenerative or protruding disc can be severe and disabling. So severe that surgery to remove the disc is needed. This procedure is called a discectomy. In this study, surgeons compare ways to reduce pain after the surgery.

Two groups of patients were included. All patients had a one-level lumbar microdiscectomy. Microdiscectomy refers to the use of a minimally invasive approach. A very small incision is made. Special surgical tools are used that allow the surgeon to see inside the spine without making a large incision.

This was the first time any of these patients had back surgery. They all had a piece of underskin (fat) harvested from their own bodies. It was then used as a patch over the epidural area. This helps prevent spinal fluid from leaking.

One group received a graft with meperidine injected into the graft before it was put over the epidural site. The other group just had the graft placed without the meperidine. Meperidine (also known as Demerol) is a fast-acting opioid analgesic (pain reliever).

All patients were given a patient-controlled analgesic (PCA) pump to use for the first 24 hours after surgery. The PCA released a small dose (20 mg) of Tramadol (a weak opioid analgesic). They were allowed to control their own drug use with at least a 10-minute interval between doses.

Results were measured based on pain severity and the amount of drug used during the first 24 hours. The authors report the group with the meperidine graft had much less pain the first hour after the operation. Total amount of pain relieving drug used was also lower in the meperidine graft group.

The authors encourage surgeons to reduce patient postoperative pain whenever possible. This can be done by minimizing trauma during the procedure. Minimally invasive techniques can be used. Tissues must be handled skillfully and carefully.

The use of a meperidine graft can also reduce pain. Proper pain control makes it possible for the patient to get up and move about sooner. Early mobilization can reduce the risk of blood clots after surgery. Patient-controlled analgesia is expensive and isn't always available. In such cases, the meperidine seeps into the epidural cavity during the first 24-hours. This effect can also reduce pain and sensation.

References: Erdal Kalkan, MD, et al. The Effect of Meperidine-Impregnated Autogenous Free Fat Grafts on Postoperative Pain Management in Lumbar Disc Surgery. In Journal of Spinal Disorders & Techniques. April 2008. Vol. 21. No. 2. Pp. 92-95.

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