Effect Of Intravenous20%Mannitol Or Dexamethasone On Low Back And Leg Pain After Lumbar Fusion Surgery

Objective:To assess the effect of intravenous mannitol or dexamethasone on low backpain and leg pain after lumbar fusion surgery by means of a prospectively randomizedcontrolled study. The results may provide evidence for postoperative patient as a superiorselection on medicine.Method:130Patients with lumbar degenerative disease were enrolled by the entrycriteria from October2012to October2013. Their age ranged form32to78years, with amean of53.6years. All patients were randomly divide into four groups, the mannitol groupreceived intravenous20%mannitol250ml at3、11、24、32、48、56h after operation;thedexamethasone group1received intravenous dexamethasone10mg at3、24、48h afteroperation; the dexamethasone group2received intravenous dexamethasone10mg at48、72、96h after operation, and the control group received neither mannitol nordexamethasone after minimally invasive surgery transforaminal interbody fusion(MIS-TLIF) and percutaneous pedicle fixation. Postoperative low back and leg pain weredetermined by using visual analogue scale (VAS) within0-96h after surgery. Operation time,intraoperative blood loss, using of analgesic after operation, and complication wererecorded. The serum level of inflammatory factors TNF-α, IL-1β, IL-6were measuredby enzyme linked immunosorbent assay (ELISA) at3,24,48,72and96h after operation.All data were analysized by the SPSS15.0statistical software.Results:1. All procedures were smoothly performed without major complications such as nerveroot injury， hematoma and infection. All of them have no significant difference in gender,age, lesion type, lesion segment, course of disease, symptom and sign(P>0.05).Therewere no significant difference in operating time and intraoperative blood loss among thefour groups (P>0.05).2. Comparison among Dexamethasone group1, mannitol group and control group.①The VAS scores of low back pain in the dexamethasone group1at3,24,48,72,96hpostoperatively have no significant difference between the mannitol group and the control group(P>0.05).The VAS scores of leg pain in the dexamethasone group1at3,24,48,72,96h postoperatively were inferior to the control group, and the scores at3,24,48,96hpostoperatively were inferior to the mannitol group(P<0.05). The VAS scores of low backpain and leg pain in the mannitol group at3,24,48,72,96h postoperatively have nosignificant difference with the control group(P>0.05)②The serum level of inflammatoryfactors TNF-α in the dexamethasone group1at3,24,48,72,96h postoperatively wereinferior to the control group, TNF-α at3,48,72,96h postoperatively were inferior to themannitol group(P<0.05); The serum level of inflammatory factors IL-1β in thedexamethasone group1at3,24,48,72h postoperatively were inferior to the control group,IL-1β at3,24,48,72,96h postoperatively were inferior to the mannitol group(P<0.05);The serum level of inflammatory factors IL-6in the dexamethasone group1at3,24,72hpostoperatively were inferior to the control group, IL-6at3,24,48h postoperatively wereinferior to the mannitol group(P<0.05).The serum level of inflammatory factors TNF-α,IL-1β, IL-6in the mannitol group have no significant difference with the controlgroup(P>0.05).3.Comparison between dexamethasone group1and dexamethasone group2.①The VAS scores of low back pain in the dexamethasone group2at3,24,48,72,96hpostoperatively have no significant difference with the dexamethasone group1(P>0.05).The VAS scores of leg pain in the dexamethasone group2were inferior to thedexamethasone group196h after surgery(P<0.05).②The serum level of inflammatoryfactors TNF-α, IL-1β, IL-6in the dexamethasone group2at72,96h postoperatively wereinferior to the dexamethasone group1(P<0.05).Conclusion:1. The serum level of inflammatory factors TNF-α, IL-1β, IL-6and the leg painwere reduced by using intravenous dexamethasone in patients receiving MIS-TLIF, but hasno significant effect on low back pain.2. Compared with using dexamethasone at3,24,48h postoperatively, usingdexamethasone at48,72,96h postoperatively can reduce the leg pain more efficiently.3. Intravenous mannitol has no significant effect on postoperative low back and legpain in patients receiving MIS-TLIF.