Postoperative analgesia for complex spinal surgery

Abstract

Purpose of reviewComplex spinal surgery is associated with significant postoperative pain. The purpose of this paper is to review recent literature on postoperative pain management in adult and adolescent patients having complex spinal surgery.Recent findingsWe conducted a literature search using the Medline database for relevant publications from 2020 to 2022 on postoperative pain after complex spinal surgery. Although opioids remain the mainstay to manage pain after complex spinal surgery, they are associated with adverse effects. Multimodal analgesia may be used to reduce these adverse effects by combining different drugs targeting different parts of the pain pathway. Recent publications suggest continuous low dose fentanyl or morphine infusion, methadone, intravenous paracetamol and ibuprofen, ketorolac, ketamine, magnesium infusion, lidocaine infusion and dexmedetomidine appear to be effective and safe to manage pain after complex spinal surgery. Regional techniques including bilateral erector spinae block, interfascial plane block and intrathecal morphine also appear to be effective and safe.SummaryPain management after complex spinal surgery remains challenging. Therefore, further studies are still required to determine the optimal multimodal analgesic regimen for these patients.

Simultaneous determination of 14 analgesics in postoperative analgesic solution by HPLC–DAD and LC–MS/MS

“…At present, opioid analgesics, nonsteroidal anti-inflammatory drugs, anesthesia, sedation and other drugs are widely used in combination for patients with self-controlled postoperative analgesia. This method can reduce the occurrence of adverse reactions while reducing the dose of a single drug and achieve a better analgesic effect [ 2 , 26 – 29 ]. However, opioids and sedatives are strictly controlled drugs in China and elsewhere, and they come with a high risk of abuse.…”

Analgesic Efficacy and Safety of Tapentadol Immediate Release in Bunionectomy: A Meta-Analysis

“…Currently, international organizations support the use of multimodal analgesia to treat postoperative pain [ 23 ]. The use of a combination of analgesics (NSAIDs, glucocorticoids, and opioids) could have many advantages, such as the induction of analgesia by different mechanisms of action, improved rapid recovery after surgery, less general toxicity, and adverse effects because the combination of drugs allows reducing the doses, particularly how much synergistic analgesic effects can be obtained using a combination of two or more drugs [ 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. It is important to mention that evidence can also be found in clinical trials on the use of other opioid analgesics alone, or in combination with other types of drugs, to treat postoperative pain after a bunionectomy, such as tramadol [ 31 , 32 ], oxycodone [ 7 , 33 , 34 , 35 ], and morphine [ 33 , 36 , 37 ].…”

Uso da metadona intravenosa na indução da anestesia para analgesia pós-operatória em cirurgias da coluna vertebral

“…Existem inúmeras estratégias técnicas para a sua administração, seja isolada ou associada a outras medicamentos (lidocaína, magnésio, dextrocetamina, cetorolaco, ibuprofeno, dexmedetomidina). 48 O uso combinado da metadona com a dextrocetamina reduz o consumo de opioide no período pós-operatório quando comparado ao uso isolado da metadona. 49 Apesar das inúmeras estratégias adotadas para tratamento da dor, existe um consenso que técnicas e estratégias para manejo satisfatório da dor ainda não foram encontradas e há necessidade de mais investigação sobre o tema.…”

“…Nos ensaios clínicos, mesmo quando são padronizados o tipo de cirurgia, a extensão da cirurgia, a via de abordagem, o estado físico, a idade, o sexo e o peso dos pacientes, a equipe cirúrgica, a equipe anestésica e as estratégias para o controle da dor, os pacientes poderão apresentar graus diferentes de intensidade dolorosa e consumir quantidades diferentes de medicamentos no período pós-operatório, pois cada paciente tem um limiar de dor próprio. [47][48][49] O uso da metadona para o controle da dor pós-operatória é uma opção terapêutica utilizada em diversos tipos de cirurgias nos dias de hoje 7,16,18,20,53 . Para obter um controle satisfatório da dor pós-operatória, a droga analgésica deve ser titulada (na dosagem e frequência de sua administração) e otimizada para que seja utilizada a menor dose analgésica eficaz possível, proporcionando menor incidência de efeitos colaterais (retenção urinária, prurido, náusea e vômito, íleo, depressão respiratória etc.).…”