Effects of local intraoperative epidural use of triamcinolone acetonide-soaked Gelfoam on postoperative outcomes in patients undergoing posterolateral lumbar spinal fusion surgery: a randomized, placebo-controlled, double-blind trial

The effect of epidural steroid injection during surgery on surgical site infections following lumbar fusion

Background

Intraoperative epidural steroid injections (ESIs) have been suggested to limit pain following lumbar fusions. However, the frequency of resultant surgical site infections has not been fully investigated.

Methods

We retrospectively followed two groups of patients; 23 patients were the control group, while the other 23 patients received, in addition to the spinal fusions, intraoperative ESI.

Results

Patients in the latter ESI/fusion treatment group had significantly increased rates of superficial and deep infections (i.e., superficial infections 17.4% and 4.3% deep infections) versus control patients (i.e., 8.6% superficial and 0% deep) undergoing fusions alone.

Conclusion

We observed an increased risk of postoperative surgical site infections among patients who underwent intraoperative ESI in addition to their lumbar fusions.

Opioid Sparing Analgesics in Spine Surgery

Combinations of various nonopioid analgesics have been used to decrease pain and opioid consumption postoperatively allowing for faster recovery, improved patient satisfaction, and decreased morbidity. These opioid alternatives include acetaminophen, NSAIDs, COX-2 specific inhibitors, gabapentinoids, local anesthetics, dexamethasone, and ketamine. Each of these drugs presents its own advantages and disadvantages which can make it difficult to implement universally. In addition, ambiguous administration guidelines for these nonopioid analgesics lead to a difficult implementation of standardization protocols in spine surgery. A focus on the efficacy of different pain modalities specifically within spine surgery was implemented to assist with this standardized protocol endeavor and to educate surgeons on limiting opioid prescribing in the postoperative period. The purpose of this review article is to investigate the various opioid sparing medications that have been used to decrease morbidity in spine surgery and better assist surgeons in managing postoperative pain. Methods. A narrative review of published literature was conducted using the search function in Google scholar and PubMed was used to narrow down search criteria. The keywords “analgesics,” “spine,” and “pain” were used.