Spine
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Randomized Controlled Trial
A Randomized Controlled Trial Using Epidural Analgesia for Pain Relief After Lumbar Interlaminar Decompressive Spine Surgery: The RAPID trial.
Prospective, double-blind randomized controlled trial. ⋯ This randomized controlled trial shows that administrating a bolus of intraoperative epidural bupivacaine is a safe and effective method for reducing early postoperative pain following lumbar decompression surgery.
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Retrospective study. ⋯ Most patients presenting for a first diagnosis of isolated LBP went to the ED relative to urgent care. The greatest drivers of urgent care versus ED utilization for LBP were insurance type and geographic region. Utilization of advanced imaging was higher among ED patients, but rates of surgical intervention were similar between those seen in the ED and urgent care.
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Randomized double-blind controlled trial. ⋯ The addition of ketorolac to bupivacaine for wound infiltration after posterior lumbar spine decompression and fusion reduces early post-operative pain and total morphine consumption as compared to bupivacaine alone.
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Retrospective Cohort. ⋯ 3.
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Prospective randomized. ⋯ Methylprednisolone instillation is associated with a large, transient reduction in ODI for patients with high preoperative ODI; there is no measurable effect on pain. There is equivocal effect on risk of subsequent reoperation. This issue was clarified in peer review but changes did not make it to the abstract. Therefore, the technique is likely best reserved for patients with significant preoperative disability.