Efficacy of topical microfibrillar collagen mixed with steroid hormone and morphine for postoperative pain control during lumbar laminectomy: a preliminary report.

Background: Current inpatient management of postoperative pain in lumbar surgery includes the use of intramuscular opioid analgesics, nonsteroidal anti-inflammatory drugs, or patient-controlled analgesia; however, all types of medications are associated with side effects that can limit their usefulness in the inpatient setting.

Methods: In a well-conducted non-randomized prospective trial, 80 consecutive patients who underwent elective multilevel lumbar laminectomy surgery were identified. Two types of trials with different doses of steroids were used. Patients' preoperative medical records, pain scores, narcotics consumption, costs for the regimen, hospital stay, unwanted complications, and walking ability were evaluated postoperatively.

Results: Pain in patients after lumbar surgery can be dramatically controlled postoperatively. Seventy-eight patients (97.5%) were able to walk without support on the first postoperative day. Major side effects were found in 5 patients (6.2%).

Conclusions: This experience indicates that pain-control agents with epidural sustained-released preparation seem to be beneficial in early mobilization, are cost effective, and require lower analgesic consumption by patients. Similar pain control can be obtained with lower doses of methylprednisolone. In spite of its clinical attractiveness, improvements in the side effects of complications from epidural morphine and the combination of steroids and microfibrillar collagen have yet to be realized.