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Recommendations for Postoperative pain management after complex spine surgery

Written By : Dr. Shravani Dali |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2021-09-13T09:00:54+05:30  |  Updated On 13 Sept 2021 9:01 AM IST
Recommendations for Postoperative pain management after complex spine surgery
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New recommendations for postoperative pain after complex spine surgery based on systemic review of past literature review were released by European researchers and have been published in the European Journal of Anaesthesiology.

Complex spinal procedures are associated with intense pain in the postoperative period. Adequate peri-operative pain management has been shown to correlate with improved outcomes including early ambulation and early discharge.

A group of European researchers performed a systematic review using the PROcedure SPECific postoperative pain managemenT methodology was undertaken. Randomised controlled trials and systematic reviews published in the English language from January 2008 to April 2020 assessing postoperative pain after complex spine surgery using analgesic, anaesthetic or surgical interventions were identified from MEDLINE, EMBASE and Cochrane Databases.

The results of the study are as follows:

  • Out of 111 eligible studies identified, 31 randomised controlled trials and four systematic reviews met the inclusion criteria.
  • Pre-operative and intra-operative interventions that improved postoperative pain were paracetamol, cyclo-oxygenase (COX)-2 specific-inhibitors or non-steroidal anti-inflammatory drugs (NSAIDs), intravenous ketamine infusion and regional analgesia techniques including epidural analgesia using local anaesthetics with or without opioids.
  • Limited evidence was found for local wound infiltration, intrathecal and epidural opioids, erector spinae plane block, thoracolumbar interfascial plane block, intravenous lidocaine, dexmedetomidine and gabapentin.

Main recommendations:

1. Systemic analgesia should include paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs) or cyclo-oxygenase (COX)-2 specific inhibitors administered pre-operatively or intra-operatively and continued postoperatively.

2. Intra-operative intravenous low-dose ketamine infusion is recommended.

3. Epidural analgesia with local anaesthetics alone or combined with opioids are recommended.

4. Opioids should be reserved as rescue analgesics in the postoperative period.

Thus, the researchers concluded that the analgesic regimen for complex spine surgery should include pre-operative or intra-operative paracetamol and COX-2 specific inhibitors or NSAIDs continued postoperatively with opioids used as rescue analgesics.

Reference:

Pain management after complex spine surgery: A systematic review and procedure-specific postoperative pain management recommendations by Piet W et. al. published in the European Journal of Anaesthesiology.

doi: 10.1097/EJA.0000000000001448



recommendationspostoperativepaineuropean journal of anaesthesiology
Source : European Journal of Anaesthesiology
Dr. Shravani Dali
Dr. Shravani Dali

    Dr. Shravani Dali has completed her BDS from Pravara institute of medical sciences, loni. Following which she extensively worked in the healthcare sector for 2+ years. She has been actively involved in writing blogs in field of health and wellness. Currently she is pursuing her Masters of public health-health administration from Tata institute of social sciences. She can be contacted at editorial@medicaldialogues.in.

    Dr. Kamal Kant Kohli
    Dr. Kamal Kant Kohli

    Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751

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