Lumbosacral Spine Acute Bony Injuries Medication

Updated: Dec 11, 2018
  • Author: Federico C Vinas, MD; Chief Editor: Sherwin SW Ho, MD  more...
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Medication

Medication Summary

If the patient arrives at the treating facility within 8 hours of the initial injury and has evidence of a spinal cord injury, 30 mg/kg of methylprednisolone should be given as a slow bolus within the first hour, followed by an infusion of 5.4 mg/kg each hour for the next 23 hours. The use of large doses of steroids can induce stress ulcers and gastritis; therefore, prophylaxis with H2 blockers and/or other antacids should be implemented. Note: This regimen of methylprednisolone is contraindicated in pregnant patients.

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Steroids

Class Summary

Steroids—in particular, methylprednisolone—have been proven in clinical trials to reduce the formation of free oxygen radicals and improve clinical outcomes following spinal cord injuries.

Related Medscape Reference topics:

Corticosteroid Injections of Joints and Soft Tissues

Corticosteroid-Induced Myopathy

Epidural Steroid Injections

Related Medscape resources:

Resource CenterSpinal Disorders

Specialty SiteOrthopaedics

Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)

Several studies have demonstrated that if started within 8 h of injury, this high-dose steroid protocol can improve outcome in patients with a spinal cord injury.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

Related Medscape Reference topic:

Opioid Toxicity

Related Medscape resources:

Resource CenterAdverse Drug Events Reporting

Resource CenterOpioids: A Guide to State Opioid Prescribing Policies

Resource CenterPain Management: Pharmacologic Approaches

Resource CenterSpinal Disorders

Morphine (Duramorph, Astramorph, MS Contin)

In the acute phase following acute lumbar bony injury, patients are severely incapacitated by severe pain. Any movement, coughing, or straining produces severe pain. Morphine sulfate is the most-used drug and can be given via IV, IM, or IV pump on demand (PCA pump). Some physicians prefer to use codeine because they consider it less sedative.

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Stool Softeners

Class Summary

Patients with spinal fractures are at risk of developing constipation and fecal impaction. In these patients, straining causes severe pain. In addition, patients with acute spinal fractures require narcotic analgesics for pain control.

Related Medscape Reference topics:

Constipation

Intestinal Motility Disorders

Opioid Toxicity

Related Medscape resources:

Resource CenterFracture

Resource CenterOpioids: A Guide to State Opioid Prescribing Policies

Resource CenterPain Management: Pharmacologic Approaches

Resource CenterSpinal Disorders

Docusate (Colace, Dialose, Surfak)

For patients who should avoid straining during defecation. Allows incorporation of water and fat into the stool, causing stool to soften.

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H2 Blockers, Antihistamine

Class Summary

Antihistamine H2 blockers are reversible competitive blockers of histamine at the H2 receptors, particularly those in the gastric parietal cells, where they inhibit acid secretion. The H2 antagonists are highly selective, do not affect the H1 receptors, and are not anticholinergic agents.

Related Medscape Reference topics:

Necrotizing Enterocolitis

Antihistamine Toxicity

Ranitidine (Zantac)

Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

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