Opioid Sparing Analgesics in Spine Surgery

Abstract

Combinations of various nonopioid analgesics have been used to decrease pain and opioid consumption postoperatively allowing for faster recovery, improved patient satisfaction, and decreased morbidity. These opioid alternatives include acetaminophen, NSAIDs, COX-2 specific inhibitors, gabapentinoids, local anesthetics, dexamethasone, and ketamine. Each of these drugs presents its own advantages and disadvantages which can make it difficult to implement universally. In addition, ambiguous administration guidelines for these nonopioid analgesics lead to a difficult implementation of standardization protocols in spine surgery. A focus on the efficacy of different pain modalities specifically within spine surgery was implemented to assist with this standardized protocol endeavor and to educate surgeons on limiting opioid prescribing in the postoperative period. The purpose of this review article is to investigate the various opioid sparing medications that have been used to decrease morbidity in spine surgery and better assist surgeons in managing postoperative pain. Methods. A narrative review of published literature was conducted using the search function in Google scholar and PubMed was used to narrow down search criteria. The keywords “analgesics,” “spine,” and “pain” were used.

Trends of Opioid Usage in Surgical Patients in a Small Community Hospital: Analysis of Patient Data Between 2017 and 2021

“…For example, an orderable for oral acetaminophen/hydrocodone would be specified for pain scale 1 to 5 while an orderable for IV morphine was reserved for pain scale 6 to 10. Additionally, nonopioid pharmacologic alternatives 21-25 like NSAIDs, acetaminophen, tramadol, gabapentin, tapentadol, and nerve block agents (bupivacaine, ropivacaine) were included in the revised PowerPlans at WCH. Based on patient’s perceived pain intensity, these agents fully or partially substituted opioids as the choice of drug for pain management prescribed by providers.…”

Pain management for the neurosurgical patient in spinal procedures: overview of historic and new modalities

“…Spinal surgery has been rated among the top six procedures causing severe pain in the initial postoperative period [23]. Consequently, substantial prescription of pain medications is critical for favorable patient outcomes [23][24][25]. Orthopedic and neurosurgery are the two surgical specialties with a higher prevalence of opioid use, and coincidentally, spinal procedures overlap [26].…”

“…The historical use of opioids in spinal disorders and procedures does not predate the concerns regarding risks associated with long-term opioid consumption. Data and justifiable trials and outcomes date back to 1996, showing the need for controlled prescription of opioids [25].…”