Complications of intraoperative epidural XXXX use in lumbar discectomy: a systematic review and meta-analysis.

@entity1667 @entity1 @entity66 @entity281 @entity158 @entity479 @entity230 @entity890
OBJECT The authors' aim in this paper was to review the intraoperative use of epidural @entity230 in lumbar discectomy surgery with a focus on surgical complications. METHODS A comprehensive literature search was done using PubMed, MEDLINE, and the Cochrane Central Registry of Controlled Trials. Relevant papers were retrieved and analyzed. The authors performed a meta-analysis of all available data. Search terms included epidural, @entity230 , discectomy, lumbar disc surgery, @entity890 , @entity1667 , and perioperative.The primary outcome was surgical complications such as wound @entity281 or need for reoperation. Secondary outcomes were @entity158 and postoperative narcotic usage. RESULTS Sixteen trials and 1 retrospective study (a total of 1933 @entity1 ) were eligible for inclusion in this study. In all studies, @entity230 were added epidurally over the nerve root before closure in cases, and control @entity1 underwent discectomy alone. The mean age (42.7 years vs 42.4 years; RR 0.30 [95% CI -0.30 to 0.90], p = 0.32), overall complication rates (2.69% vs 1.18%; RR 1.94 [95% CI 0.72-5.26], p = 0.19), and infectious complication rates (0.94% vs 0.08%; RR 4.58 [95% CI 0.75-27.95], p = 0.10) were similar between the @entity479 group and control group, respectively. CONCLUSIONS There is good evidence that epidural @entity230 can decrease @entity158 in the short term and decrease the usage of postoperative narcotics after lumbar spinal surgery for degenerative @entity66 . The authors' results demonstrate a trend toward @entity281 with epidural @entity479 use, but there was not a statistically significant difference. More studies are needed to validate the long-term risk/benefit ratio of epidural @entity230 in lumbar discectomy.
