Nonsteroidal antiinflammatory drugs for postoperative pain management after lumbar spine surgery: a meta-analysis of randomized controlled trials

Jirarattanaphochai, Kitti; Jung, Surachai

doi:10.3171/spi/2008/9/7/022

Cited by 79 publications

(45 citation statements)

References 51 publications

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“…4 Current regimens involve the use of opioid, nonopioid analgesics, and/or local anesthetics. [5][6][7] Local infiltration of anesthetics in the surgical site during wound closure is commonly performed with lumbar spine surgery. 8,9 These agents are traditionally used to provide postoperative analgesia, but the effects are limited by dosing restrictions due to potential systemic side effects from peak plasma concentrations.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

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Section: Introductionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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“…Nurses in Ghana do not administer regular analgesics post-operatively and analgesics are not administered pre-emptively (Aziato & Adejumo, 2014a). Clear specific statements on contemporary recommendations for POP such as regular administration of analgesic, using more than one form of analgesic for POP, and giving the drug before patient experiences pain have been found to improve POP management (Jirarattanaphochai & Jung, 2008;Joshi, Rawal, Kehlet, & The PROSPECT collaboration, 2011;Paice, Noskin, Vanagunas, & Shott, 2005). The authors reflect on the approach used for this study.…”

Section: Discussionmentioning

confidence: 94%

“…SR to examine who would most benefit from postop education, type or approach, and dose of education Delivery of postop patient education through the individualisation of content, use of combined media for delivery, provision of education on a one-on-one basis, and in multiple sessions is associated with improvement in educational or health outcomes Patient education improves health/ education outcomes such as better POP management Cummings et al (2010) SR to examine the relationships between various styles of leadership outcomes for the nursing workforce and their work environment Leadership styles that focused on people and relationships (transformational, resonant, supportive, and consideration) were associated with nurse job satisfaction and leadership styles focused on task (dissonant, instrumental, and management by exception) were associated with lower nurse job satisfaction Emphasises effective leadership improves workforce Jirarattanaphochai and Jung (2008) SR to assess the efficacy and safety of nonsteroidal anti-inflammatory drugs (NSAIDS) in addition to analgesics on POP management in lumber surgery…”

Section: Participant/expert Reviewmentioning

confidence: 98%

Developing a context appropriate clinical guideline for post-operative pain management in Ghana: A participatory approach

Aziato

Adejumo

2015

International Journal of Africa Nursing Sciences

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a b s t r a c tClinical guidelines involve statements that guide clinicians to provide effective care to patients. However, there are no context appropriate clinical guidelines for post-operative pain (POP) management in Ghana. This study sought to develop such a clinical guideline. The study adopted a participatory approach drawing from the existing literature to develop the guideline with the involvement of 27 experts and stakeholders including nurses, doctors, anaesthetists, pharmacists, patients, and patients' relatives. Also, the guideline statements were discussed and finalised at a multidisciplinary consensus forum made up of 29 members. Consensus was achieved by employing procedures similar to a modified nominal group technique. Purposive sampling was employed. The guideline was made up of four dimensions described in a conceptual Radial Venn which emphasised inter-relationships among patient and family education, team work, monitoring and input by hospital leadership, and application of appropriate scientific recommendations for POP management. The effective collaboration with stakeholders resulted in the adoption of the clinical guideline by the Ghana Health Service for use within the Ghanaian health system.

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“…A recent meta-analysis concluded that the literature to date supports that patients receiving NSAID in addition to opioid analgesics had lower pain scores and consumed fewer opioids than patients receiving opioids alone [27]. Nevertheless, nonselective NSAID have historically been avoided by spine surgeons due to animal models that demonstrated inhibition of osteoblast cell production and bone metabolism [12].…”

Section: Nsaidmentioning

confidence: 98%