Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Peene, Laurens; Cacheux, Pauline Le; Sauter, Axel R.; Joshi, Girish P.; Beloeil, Hélène

doi:10.1007/s00586-020-06661-8

Cited by 30 publications

(32 citation statements)

References 47 publications

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“…Nevertheless, we believe that this questionnaire based analysis provides important aspects and insights to possibilities of non-opioid therapy for postoperative pain. As mentioned above, in several other surgical fields sufficient postoperative pain control with NSAI Ds comparable or even superior to opioids has been shown in randomized studies and meta-analyses [16,17,24,25]. Primarily, treatment of pain following otologic surgery should therefore be attempted without opioids.…”

Section: Discussionmentioning

confidence: 98%

Is otologic surgery contributing to the opioid epidemic?

Dahm

Lui

Liepins

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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Background The opioid epidemic is a significant public health crisis challenging the lives of North Americans. Interestingly, this problem does not exist to the same extent in Europe. Surgeons play a significant role in prescribing opioids, especially in the context of post-operative pain management. The aim of this study was to compare the post-surgical prescribing patterns of otologists comparing Canada and Austria. Methods An online questionnaire was sent to 33 Canadian and 32 Austrian surgeons, who perform otologic surgery on a regular basis. Surgeons were asked to answer some questions about their background as well as typical prescribing patterns for postoperative pain medication for different ear surgeries (cochlear implant, stapedotomy, tympanoplasty). In addition, surgeons were asked about the typical use of local anesthetics for pain control at the end of a procedure. Otologists gave an estimate how confident they were that their therapy and prescriptions provide sufficient pain control to their patients. Results Analysis of the returned questionnaires showed that opioids are more commonly prescribed in Canada than in Austria. Nonsteroidal anti-inflammatory drugs are used for postoperative pain more regularly after ear surgery in Austria, as opposed to Canada. Some of the prescribed drugs by European otologists are not available in North America. The use of local anesthetics at the end of surgery is not common in Austria. Surgeons´ confidence that the prescribed pain medication was sufficient to control postoperative symptoms was higher in the group not prescribing opioids than in the group that did routinely prescribe opioids. Conclusion Prescribing patterns differ substantially between the two evaluated countries. This data suggests an opportunity to reduce opioid prescriptions after otologic surgeries. Studies to evaluate pain after these operations as well as efficacy of analgesics following ear surgery are an important next step. Graphical abstract

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Section: Discussionmentioning

confidence: 98%

Is otologic surgery contributing to the opioid epidemic?

Dahm

Lui

Liepins

et al. 2021

Journal of Otolaryngology - Head & Neck Surgery

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“…Moreover, the changes in sagittal alignment are correlated with pain severity [21]. Multimodal pain management including paracetamol and non-steroidal analgesic drugs (NSAIDs) or cicloxygenasys-2 (COX-2) speci c inhibitors, the intraoperative use of a low-dose ketamine infusion, and the postoperative use of an epidural infusion of LA are actually recommended for pain control after spine surgery [7,8]. As rescue analgesia opioids are still widely used [7,8].…”

Section: Discussionmentioning

confidence: 99%

“…Multimodal pain management including paracetamol and non-steroidal analgesic drugs (NSAIDs) or cicloxygenasys-2 (COX-2) speci c inhibitors, the intraoperative use of a low-dose ketamine infusion, and the postoperative use of an epidural infusion of LA are actually recommended for pain control after spine surgery [7,8]. As rescue analgesia opioids are still widely used [7,8]. Opioids are highly effective on postoperative pain; however, drawbacks of opioids include opioid-induced hyperalgesia and adverse effects such as nausea, gastrointestinal dysmotility, respiratory depression, and risk of opioid habituation [8,9].…”

Section: Discussionmentioning

confidence: 99%

“…The recent work from the PROSPECT groups tried to identify the analgesic regimen for optimal pain management after spine surgery, recommending multimodal pain management [7][8][9]. More recently, pathways of care for spine surgery which emphasize opioid-sparing local anesthetic-based regional techniques have been described [1,7,8,[10][11][12][13]]. A regional technique suitable for spine surgery should cover the innervation of the relevant vertebrae and paravertebral muscles and include the dorsal roots of the spinal nerves at the level of surgery [14].…”

Section: Introductionmentioning

confidence: 99%

“…An adequate control of postoperative pain after spine surgery is critical and leads to reduced postoperative complications and length of hospital stay [1][2][3][4][5][6]. The recent work from the PROSPECT groups tried to identify the analgesic regimen for optimal pain management after spine surgery, recommending multimodal pain management [7][8][9]. More recently, pathways of care for spine surgery which emphasize opioid-sparing local anesthetic-based regional techniques have been described [1,7,8,[10][11][12][13]].…”

Section: Introductionmentioning

confidence: 99%

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Bilateral lumbar Ultrasound-guided Erector Spinae Plane Block versus Local Anaesthetic Infiltration for Perioperative Analgesia in Lumbar Spine Surgery: A Randomized Controlled Trial

Vergari¹,

Frassanito²,

Muro³

et al. 2021

Preprint

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BackgroundLumbar spinal surgery is associated with severe postoperative pain. We examined the analgesic efficacy of bilateral lumbar ultrasound-guided erector spinae plane block (ESPB) with ropivacaine compared with local infiltration of ropivacaine.Methods Twenty-four patients undergoing elective lumbar arthrodesis were randomly divided into two groups. Control group received 0.375 % ropivacaine 40 ml through the wound, and ESPB group received preoperative bilateral ESPB with 0.375 % ropivacaine 40 ml. The primary outcome was postoperative pain intensity at rest using a Numeric Rating Scale (NRS). Secondary outcomes included difference in pain intensity between pre-intervention and defined timepoints, total amount of opioid analgesic requested by the patients at the same timepoints, the incidence of any adverse event, and the length of hospital stay (LOS) after surgery.Results After surgery we detected a NRS value of 1.9 + 1.6 in ESPB group and 6.0 + 1.7 in Control group (p<0.05). In the ESPB group we found a significant decrease (from 6.3 ± 1.6 to 1.9 ± 1.7) of NRS score after surgery compared to pre-surgery values. About the opioid consumption we found a total sufentanil tablets consumption of 17 ± 9 and 10 ± 2 at 48h for Control group and ESPB group, respectively. Concerning LOS all patients in the Control group and 9 of the ESPB group were discharged after 72 hours; 3 patients in the ESPB group left the ward after 48 hours. Conclusion Bilateral ultrasound-guided ESPB offers improved postoperative analgesia compared with local infiltration in patients undergoing lumbar spinal surgery.Trial Registration Number on Clinicaltrial.gov: NCT04123106

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Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery

Tsai,

Hu,

El Sammak

et al. 2023

JAMA Netw Open

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IMPORTANCEPatients undergoing spine surgery often experience severe pain. The optimal dosage of pregabalin and gabapentin for pain control and safety in these patients has not been well established.OBJECTIVETo evaluate the associations of pain, opioid consumption, and adverse events with different dosages of pregabalin and gabapentin in patients undergoing spine surgery.DATA SOURCESPubMed/MEDLINE, Embase, Web of Science, Cochrane library, and Scopus databases were searched for articles until August 7, 2021.STUDY SELECTIONRandomized clinical trials conducted among patients who received pregabalin or gabapentin while undergoing spine surgery were included.DATA EXTRACTION AND SYNTHESISTwo investigators independently performed data extraction following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guideline. The network meta-analysis was conducted from August 2022 to February 2023 using a random-effects model.MAIN OUTCOMES AND MEASURESThe primary outcome was pain intensity measured using the Visual Analog Scale (VAS), and secondary outcomes included opioid consumption and adverse events.RESULTSTwenty-seven randomized clinical trials with 1861 patients (median age, 45.99 years [range, 20.00-70.00 years]; 759 women [40.8%]) were included in the systematic review and network meta-analysis. Compared with placebo, the VAS pain score was lowest with gabapentin 900 mg per day, followed by gabapentin 1200 mg per day, gabapentin 600 mg per day, gabapentin 300 mg per day, pregabalin 300 mg per day, pregabalin 150 mg per day, and pregabalin 75 mg per day. Additionally, gabapentin 900 mg per day was found to be associated with the lowest opioid consumption among all dosages of gabapentin and pregabalin, with a mean difference of −22.07% (95% CI, −33.22% to −10.92%) for the surface under the cumulative ranking curve compared with placebo. There was no statistically significant difference in adverse events (nausea, vomiting, and dizziness) among all treatments. No substantial inconsistency between direct and indirect evidence was detected for all outcomes.CONCLUSIONS AND RELEVANCEThese findings suggest that gabapentin 900 mg per day before spine surgery is associated with the lowest VAS pain score among all dosages. In addition, no differences in adverse events were noted among all treatments.

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Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Cited by 30 publications

References 47 publications

Is otologic surgery contributing to the opioid epidemic?

Is otologic surgery contributing to the opioid epidemic?

Bilateral lumbar Ultrasound-guided Erector Spinae Plane Block versus Local Anaesthetic Infiltration for Perioperative Analgesia in Lumbar Spine Surgery: A Randomized Controlled Trial

Different Gabapentin and Pregabalin Dosages for Perioperative Pain Control in Patients Undergoing Spine Surgery

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