Resumo

ALDRETE, J. A.; GUEVARA, U.; ARENOSO, H. J.  e  CERASO, O. L.. Efficacy and tolerability of epidural steroids vs low doses of steroids plus metamizol plus propoxyphene administered paravertebrally for postaminectomy syndrome patients. Rev. Soc. Esp. Dolor [online]. 2006, vol.13, n.7, pp.454-461. ISSN 1134-8046.

As the clinical applications of the central antinociceptive action of the non-steroidal antiinflammatory agents have been recognized, their combination with mild doses of opiods has been explored in order to be able to reduce or eliminate the repetitious usage of steroids. A group of 152 adult patients with recurrent radiculopathy after the first laminectomy, at either L4-L5 or L5-S1 levels, in whom periradicular fibrosis and scarring had been shown at MRI exam, was separated at random into two subgroups. Subgroup A included 69 patients that were treated with four epidural injections of 80mg of methylprednisolone (MTP) in 3ml of 0.25% bupivacaine (BPV). Changes in pain level, physical activity and the type of medications used were followed using the Pain Progress Score that evaluates five parameters graded from 0 to 2, before initiating treatment and again before each of the three subsequent injections, given at three week intervals. Subgroup B included 73 patients treated by paravertebral injections of 40mg of MTP, 50mg of dipyrone (DPN), 12.5mg of propoxyphene (PPX) and 1ml of 0.5% BPV at the L4-L5 and L5-S1 spaces, bilateral. All patients improved clinically without observing statistically significant differences between the two groups; however, there was a significant difference (p< 0.05) when the post-treatment scores were compared to the control values, at every evaluation. There was however an important variant, as the patients in group A had more side effects (increased weight, edema, echymosis and moon fascies) and developed complications derived from the epidural injections (3 incidental dural punctures, two postdural puncture headaches, one of which required an epidural blood patch, as treatment). Similar clinical improvement was seen from either of the two treatment modalities studied; however, since most of the side effects and the morbidity typically observed after a series of epidural injections of steroids can be obviated by administering a reduced dose of steroids, an antiinflamatory agent and a low dose opiate in the paravertebral spaces adjacent to the previously operated level, this therapeutic alternative is recommended.

Palavras-chave : antiinflamatories; steroids; epidural; propoxy-fene; dypirone; paravertebral.

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