Lumbar discectomy: use of an epidural XXXX sponge for postoperative pain control.

@entity1 @entity1512 @entity773 @entity1337 @entity1286 @entity158 @entity1443 @entity8745 @entity130
A technique for extended ambulatory @entity158 control after lumbar discectomy is described; preliminary results with 45 @entity1 are reported; and alternative methods of narcotic @entity1337 are reviewed. In this technique, an absorbable gelatin sponge (Gelfoam, Upjohn Co., Kalamazoo, MI) is contoured to the laminotomy defect, placed in @entity8745 (40-80 mg), and then injected with 2 to 4 mg of preservative-free @entity1286 (a small needle was used to fill the sponge). The sponge is placed over the defect before closure. A review of office and hospital records was conducted. The series consisted of 33 @entity1 and 12 @entity1 (mean age, 39 yr; range, 24-57 yr); records showed narcotic use in 34 @entity1 (parenteral in 3) and work-related @entity130 in 14 @entity1 . Thirty-three @entity1 were ambulatory postoperatively on the day of surgery; all were ambulatory by postoperative day (POD) 1. On the day of surgery, 18 @entity1 did not require any postoperative analgesics; on @entity773 , 22 @entity1 did not require analgesics. Six @entity1 received parenteral narcotics; four received one dose only, and two had two or more doses. Thirty-one @entity1 were discharged from the hospital on @entity773 , and 10 were discharged POD 2. The other @entity1 were discharged from the hospital on POD 3 (three @entity1 ) or POD 4 (one @entity1 ). When they were discharged, all @entity1 received a limited supply of @entity1443 with codeine for @entity158 control at home. After discharge, phone follow-up (at 1 week) and office follow-ups (at 3-5 weeks) revealed only one @entity1 with more than mild discomfort. Three @entity1 required one-time bladder catheterization, and one @entity1 had presumed @entity1512 1 month postoperatively. In a control group who had undergone surgery 3 months previously, the average day of discharge had been POD 3.07; no control @entity1 had been discharged on @entity773 , and only 20% had been discharged on POD 2. This method provides effective, safe, and extended @entity1337 after lumbar discectomy.
