International Journal of General Medicine (May 2022)

Management of Postoperative Pain in Patients Following Spine Surgery: A Narrative Review

  • Prabhakar NK,
  • Chadwick AL,
  • Nwaneshiudu C,
  • Aggarwal A,
  • Salmasi V,
  • Lii TR,
  • Hah JM

Journal volume & issue
Vol. Volume 15
pp. 4535 – 4549

Abstract

Read online

Nitin K Prabhakar,1 Andrea L Chadwick,2 Chinwe Nwaneshiudu,3 Anuj Aggarwal,4 Vafi Salmasi,4 Theresa R Lii,4 Jennifer M Hah4 1Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA; 2Department of Anesthesiology, Pain, and Perioperative Medicine, University of Kansas School of Medicine, Kansas City, KS, USA; 3Department of Anesthesiology, Perioperative and Pain Management, Mount Sinai Hospital, Icahn School of Medicine, New York, NY, USA; 4Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, USACorrespondence: Jennifer M Hah, Email [email protected]: Perioperative pain management is a unique challenge in patients undergoing spine surgery due to the increased incidence of both pre-existing chronic pain conditions and chronic postsurgical pain. Peri-operative planning and counseling in spine surgery should involve an interdisciplinary approach that includes consideration of patient-level risk factors, as well as pharmacologic and non-pharmacologic pain management techniques. Consideration of psychological factors and patient focused education as an adjunct to these measures is paramount in developing a personalized perioperative pain management plan. Understanding the currently available body of knowledge surrounding perioperative opioid management, management of opioid use disorder, regional/neuraxial anesthetic techniques, ketamine/lidocaine infusions, non-opioid oral analgesics, and behavioral interventions can be useful in developing a comprehensive, multi-modal treatment plan among patients undergoing spine surgery. Although many of these techniques have proved efficacious in the immediate postoperative period, long-term follow-up is needed to define the impact of such approaches on persistent pain and opioid use. Future techniques involving the use of precision medicine may help identify phenotypic and physiologic characteristics that can identify patients that are most at risk of developing persistent postoperative pain after spine surgery.Keywords: postoperative pain, spine, surgery, opioid sparing, regional anesthesia, ketamine, lidocaine

Keywords