Postoperative analgesic options after spine surgery: finding the optimal treatment strategies

ABSTRACT

Introduction

Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes.

Areas covered

This review presents several options for analgesia following spine surgery with an emphasis on multimodal techniques to best aid this specific patient population. In addition to traditional therapeutics, such as acetaminophen, non-steroidal anti-inflammatory medications, and opioids, we discuss intrathecal morphine administration and emerging regional anesthesia techniques.

Expert opinion

Several adjuncts to improve analgesia following spine surgery are efficacious in the postoperative period. Intrathecal morphine provides sustained analgesia and can be instilled intraoperatively by the surgical team under direct visualization. Local anesthetics deposited under ultrasound guidance by an anesthesiologist trained in regional techniques also provide the opportunity for single injections or continuous analgesia via an indwelling catheter.

KEYWORDS:

• Analgesic adjuncts
• multimodal analgesia
• postoperative analgesia
• regional anesthesia
• spine surgery

Article highlights

• Estimated 900,000 spine surgeries are performed in the United States annually, with incidence likely to increase with an aging population.

• Acute and chronic pain post-spine surgery has historically been addressed with a pain management regimen that utilizes significant opioid therapy. Chronic opioid prescription has been linked to opioid use disorders, overdoses, and deaths, necessitating better opioid stewardship practices including optimized multimodal pain control.

• Pharmacotherapy including acetaminophen, non-steroidal anti-inflammatory drugs, muscle relaxants, gabapentinoids, and opioids – including methadone and intrathecal morphine – need be used strategically and contentiously in combination with regional anesthetic techniques to optimize pain control.

• When formulating postoperative pain control regimens, care must be taken to consider side effects of pharmacological choices, and carefully appraise patient risk factors.

• Robust studies investigating the relative efficacies of treatment plans post-spine surgery are limited by the breadth of diversity in spinal procedures.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.