The Effects of Ketorolac Injected via Patient Controlled Analgesia Postoperatively on Spinal Fusion
1
조회
0
다운로드
1
인용
0
참고문헌
초록
Abstract
Lumbar spinal fusions have been performed for spinal stability, pain relief and improved function in spinal stenosis, scoliosis, spinal fractures, infectious conditions and other lumbar spinal problems. The success of lumbar spinal fusion depends on multifactors, such as types of bone graft materials, levels and numbers of fusion, spinal instrumentation, electrical stimulation, smoking and some drugs such as nonsteroidal anti-inflammatory drugs (NSAIDs). From January 2000 to December 2001, 88 consecutive patients, who were diagnosed with spinal stenosis or spondylolisthesis, were retrospectively enrolled in this study. One surgeon performed all 88 posterolateral spinal fusions with instrumentation and autoiliac bone graft. The patients were divided into two groups. The first group (n=30) was infused with ketorolac and fentanyl intravenously via patient controlled analgesia (PCA) postoperatively and the second group (n=58) was infused only with fentanyl. The spinal fusion rates and clinical outcomes of the two groups were compared. The incidence of incomplete union or nonunion was much higher in the ketorolac group, and the relative risk was approximately 6 times higher than control group (odds ratio: 5.64). The clinical outcomes, which were checked at least 1 year after surgery, showed strong correlations with the spinal fusion status. The control group (93.1%) showed significantly better clinical results than the ketorolac group (77.6%). Smoking had no effect on the spinal fusion outcome in this study. Even though the use of ketorolac after spinal fusion can reduce the need for morphine, thereby decreasing morphine related complications, ketorolac used via PCA at the immediate postoperative state inhibits spinal fusion resulting in a poorer clinical outcome. Therefore, NSAIDs such as ketorolac, should be avoided after posterolateral spinal fusion
참고문헌 (29)
- "A Clinical study of 52 cases of posterolaterally fused lumbar spine", pp.585~94
- "Comparative study of fusion rate in the thoracolumbar and lumbar posterolateral fusion using autograft or xenograft lubboc", 4, pp.43~51 (1997)
- "An experimental lumbar intertransverse process spinal fusion model- radiographic, histologic, and biomechanical healing characteristics.", 20, pp.412~20 (1995)
- "Anterior interbody fusion in the treatment of the lumbar herniated nucleus pulposus", 40, pp.256~64 (1999)
- "A comparison of host response to cortical autograft and processed calf heterograft", pp.842~6
- "Direct current electrical stimulation increases the fusion rate of spinal fusion cages", 25, pp.2580~7 (2000)
- "Recombinant human bone morphogenetic protein-2 overcomes the inhibitory effect of ketoloac, a nonsteroidal anti inflammatory drugs (NSAID) on posterolateral lumbar intertransverse process spine fusion.", 24, pp.2188~96 (1999)
- "The rate of pseudoarthrosis in patients who are smokers and patients who are nonsmokers", pp.942~3
- "Dose-response of ketoloac as an adjunct to patient- controlled analgesia morphine in patients after spinal fusion surgery", 87, pp.98~102 (1998)
- "Intravenous administration of propacetamol reduces morphine consumption after spinal fusion surgery", 92, pp.1473~6 (2001)
- "The role of anti-inflammatory medications in the prevention of heterotopic ossification", pp.78~86, Kjaersgaard-Anderson P
- "Inhibitory effect of ibuprofen on spinal fusion in rabbits" (1994)
- "The effects of nonsteroidal anti inflammatory drugs on posterior spinal fusions in rat", 21, pp.1870~6 (1996)
- "The effect of postoperative nonsteroidal anti-inflammatory drugs administration on spinal fusion", 23, pp.834~8 (1998)
- "The use of Ketololac in lumbar spine surgery", 8, pp.206~12 (1995)
- "Results of in situ fusion for isthmic spondylolisthesis", pp.433~42
- "Anterior interbody fusion versus posterolateral fusion with transpedicular fixation for isthmic spondylolithesis", 24, pp.812~7 (1999)
- "The effect of ketorolac on recovery after anorectal surgery: Intravenous versus local administration", 90, pp.1107~10 (2000)
- "Time-dependent inhibitory effects of indomethacin on spine fusion", 85, pp.632~6 (2003)
- "Cox-2 selective NSAID decrease bone growth in vivo", 20, pp.1164~72 (2002)
- "The effect of cyclooxygenase-2 inhibitors on spinal fusion", 84, pp.1763~8 (2002)
- "Considerations in the use of Cox-2 inhibitors in spinal fusion surgery", 93, pp.803~4 (2001)
- "Differential inhibition of fracture healing by non-selective and cyclooxygenase-2 selective non-steroidal anti-inflammatory drugs", 21, pp.670~5 (2003)
- "The role of cyclooxygenase-2 in lumbar disc herniation", 27(ru d), pp.2477~83 (2002)
- "Effect of COX-2-specific inhibition on fracture healing in the rat femur", 86, pp.116~23 (2004)
- "The role of cyclo oxygenase-2 in lumbar disc herniation", 27, pp.2477~83 (2002)
- "The effect of cigarette smoking and smoking cessation and spinal fusion", 25, pp.2608~15 (2000)
- "Posterior-posterobilateral fusion of the lumbosacral spine", 47, pp.165~73 (1996)
- "Repair of a pseudoarthrosis of lumbar spine", 78, pp.712~20 (1996)