Changes of Muscle Related Enzymes after Posterior Approaches to the Lumbar Spine

OBJECTIVE: Creatine phosphokinase-MM(CPK-MM) and lactate dehydrogenase(LDH) are well known indices of muscular injury. To know the degree of muscular injury during spinal surgery, the author report serial measurement of serum CPK-MM and LDH4 level. METHODS: The authors investigated 23 patients who underwent lumbar spinal surgery without bone fusion or instrumentation. Peripheral venous blood samples were serially collected 1 day before surgery, operation day, postoperative 3rd, 7th, 14th and 28th day. Postoperative back pain was measured by visual analogue scale. We evaluated the relationship between number of operation level, serial changes of serum CPK-MM, LDH4, duration of surgery and postoperative back pain. RESULTS: CPK-MM activity was higher after surgery than before it and reached at maximal level on the postoperative 3rd day, and it was returned to normal level on the postoperative 7th day. The score of postoperative back pain scale was the highest on the postoperative 3rd day. CPK-MM activity was significantly correlated with operation level, duration of surgery, and postoperative back pain(P0.05). CONCLUSION: Postoperative muscle injury is inevitable in all patient who underwent spinal surgery, and these injuries are related extent of exposure and duration of surgery. To reduce muscle injury and postoperative back pain, less invasive and shorter surgery in time is recommend.

The Effect of Diclofenac Sodium on Uncontrolled Postoperative Back Pain by IV-PCA / 대한마취과학회지

BACKGROUND: Although postoperative back pain has been reported to occur, as a frequent complication of anesthesia and surgery, it is usually mild and self-limited. However, we experienced cases of uncontrolled postoperative back pain in patients even after IV-PCA administration. These patients' back pain was relieved by the traditional diclofenac sodium intramuscular injection, so we evaluated the efficacy of diclofenac sodium on uncontrolled postoperative back pain by IV-PCA. METHODS: We studied 16 patients who complained of postoperative back pain even with IV-PCA for postoperative pain control. When NRS pain score was above 5, the patients were treated with a diclofenac sodium 75 mg intramuscular injection. Postoperative back pain and operation site pain was measured by NRS before and after diclofenac sodium injection. RESULTS: There was a significant decrease in the pain score of postoperative back pain after diclofenac sodium injection without a dramatic improvement of operation site pain. CONCLUSIONS: Diclofenac sodium plays a useful role in the control of acute postoperative back pain.