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Analgesia and Anesthesia to Enable Outpatient Spine Surgery

  • Ramesh M. Singa
  • Asokumar Buvanendran
Chapter

Abstract

Minimally invasive spine surgery (MISS) is a rapidly growing approach that offers many benefits over traditional open spine surgery (TOSS), including reduced rates of complication, decreased pain, and faster recovery. However, these positive outcomes are only possible with an appropriate anesthetic and analgesic plan. Therefore, surgeons and anesthesiologists should discuss the preoperative evaluation, anesthetic technique, analgesia, postoperative care, and certain special considerations prior to the day of surgery. Subsequent plans and expected outcomes should be explained to the patient with the aim of answering any questions and addressing any concerns.

Keywords

Minimally invasive spine surgery anesthesia Minimally invasive spine surgery analgesia Nonsteroidal anti-inflammatory drugs (NSAIDs) in minimally invasive spine surgery Minimally invasive spine surgery anesthetic technique Minimally invasive spine surgery neuromonitoring 

References

  1. 1.
    Wood, M. Global MIS spine market to expand at 7.57% CAGR until 2020. Market analyst research; 2017. http://www.beckersspine.com/mis/item/35151-global-mis-spine-market-to-expand-at-7–57-cagr-until-2020.html. Accessed 27 June 2017.
  2. 2.
    Phillips FM, Cheng I, Rampersaud YR, Akbarnia BA, Pimenta L, Rodgers WB, Uribe JS, Khanna N, Smith WD, Youssef JA, Sulaiman WA, Tohmeh A, Cannestra A, Wohns RN, Okonkwo DO, Acosta F, Rodgers EJ, Andersson G. Breaking through the “Glass Ceiling” of minimally invasive spine surgery. Spine (Phila Pa 1976). 2016;41(Suppl 8):S39–43.  https://doi.org/10.1097/BRS.0000000000001482.CrossRefGoogle Scholar
  3. 3.
    Huang TJ, Kim KT, Nakamura H, Yeung AT, Zeng J. The state of the art in minimally invasive spine surgery. Biomed Res Int. 2017;2017:6194016.  https://doi.org/10.1155/2017/6194016.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Goldstein CL, Macwan K, Sundararajan K, Rampersaud YR. Perioperative outcomes and adverse events of minimally invasive versus open posterior lumbar fusion: meta-analysis and systematic review. J Neurosurg Spine. 2016;24(3):416–27.  https://doi.org/10.3171/2015.2.SPINE14973.CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Gupta A. Strategies for outpatient anaesthesia. Best Pract Res Clin Anaesthesiol. 2004;18(4):675–92.CrossRefGoogle Scholar
  6. 6.
    Goldfarb CA, Bansal A, Brophy RH. Ambulatory surgical centers: a review of complications and adverse events. J Am Acad Orthop Surg. 2017;25(1):12–22.  https://doi.org/10.5435/JAAOS-D-15–00632.CrossRefPubMedGoogle Scholar
  7. 7.
    Edwards AF, Slawski B. Preoperative clinics. Anesthesiol Clin. 2016;34(1):1–15.  https://doi.org/10.1016/j.anclin.2015.10.002.CrossRefPubMedGoogle Scholar
  8. 8.
    Riggs KR, Segal JB. What is the rationale for preoperative medical evaluations? A closer look at surgical risk and common terminology. Br J Anaesth. 2016;117(6):681–4.CrossRefGoogle Scholar
  9. 9.
    Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT, Nickinovich DG, American Society of Anesthesiologists Task Force on Preanesthesia Evaluation, Pasternak LR, Arens JF, Caplan RA, Connis RT, Fleisher LA, Flowerdew R, Gold BS, Mayhew JF, Nickinovich DG, Rice LJ, Roizen MF, Twersky RS. Practice advisory for preanesthesia evaluation: an updated report by the American Society of Anesthesiologists Task Force on Preanesthesia Evaluation. Anesthesiology. 2012;116(3):522–38.  https://doi.org/10.1097/ALN.0b013e31823c1067.CrossRefGoogle Scholar
  10. 10.
    Martini RP, Larson DM. Clinical evaluation and airway management for adults with cervical spine instability. Anesthesiol Clin. 2015;33(2):315–27.  https://doi.org/10.1016/j.anclin.2015.02.004.CrossRefPubMedGoogle Scholar
  11. 11.
    American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Practice guidelines for the perioperative management of patients with obstructive sleep apnea: an updated report by the American Society of Anesthesiologists Task Force on Perioperative Management of patients with obstructive sleep apnea. Anesthesiology. 2014;120(2):268–86.  https://doi.org/10.1097/ALN.0000000000000053.CrossRefGoogle Scholar
  12. 12.
    Chung F, Abdullah HR, Liao P. STOP-Bang questionnaire: a practical approach to screen for obstructive sleep apnea. Chest. 2016;149(3):631–8.  https://doi.org/10.1378/chest.15–0903.CrossRefPubMedGoogle Scholar
  13. 13.
    Corso RM, Petrini F, Buccioli M, Nanni O, Carretta E, Trolio A, et al. Clinical utility of preoperative Screening with STOP-Bang questionnaire in elective surgery. Minerva Anestesiol. 2014;80:877–84.PubMedGoogle Scholar
  14. 14.
    Deiner S, Osborn IP. Stop! Bang the drum slowly, proceed with caution when assessing obstructive sleep apnea. Minerva Anestesiol. 2014;80(8):867–8.PubMedGoogle Scholar
  15. 15.
    Elgafy H, Hamilton R, Peters N, Paull D, Hassan A. Critical care of obese patients during and after spine surgery. World J Crit Care Med. 2016;5(1):83–8.  https://doi.org/10.5492/wjccm.v5.i1.83.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY. The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976). 2008;33(16):1789–92.  https://doi.org/10.1097/BRS.0b013e31817b8f6f.CrossRefGoogle Scholar
  17. 17.
    Lee D, Armaghani S, Archer KR, Bible J, Shau D, Kay H, Zhang C, McGirt MJ, Devin C. Preoperative opioid use as a predictor of adverse postoperative self-reported outcomes in patients undergoing spine surgery. J Bone Joint Surg Am. 2014;96(11):e89.CrossRefGoogle Scholar
  18. 18.
    Villavicencio AT, Nelson EL, Kantha V, Burneikiene S. Prediction based on preoperative opioid use of clinical outcomes after transforaminal lumbar interbody fusions. J Neurosurg Spine. 2017;26(2):144–9.  https://doi.org/10.3171/2016.7.SPINE16284.CrossRefPubMedGoogle Scholar
  19. 19.
    Armaghani SJ, Lee DS, Bible JE, Archer KR, Shau DN, Kay H, Zhang C, McGirt MJ, Devin CJ. Preoperative opioid use and its association with perioperative opioid demand and postoperative opioid independence in patients undergoing spine surgery. Spine (Phila Pa 1976). 2014;39(25):E1524–30.  https://doi.org/10.1097/BRS.0000000000000622.CrossRefGoogle Scholar
  20. 20.
    Faour M, Anderson JT, Haas AR, Percy R, Woods ST, Ahn UM, Ahn NU. Preoperative opioid use: a risk factor for poor return to work status after single-level cervical fusion for radiculopathy in a workers’ compensation setting. Clin Spine Surg. 2017;  https://doi.org/10.1097/BSD.0000000000000545.CrossRefGoogle Scholar
  21. 21.
    Nguyen LC, Sing DC, Bozic KJ. Preoperative reduction of opioid use before total joint arthroplasty. J Arthroplast. 2016;31(9 Suppl):282–7.  https://doi.org/10.1016/j.arth.2016.01.068.CrossRefGoogle Scholar
  22. 22.
    Coluzzi F, Bifulco F, Cuomo A, Dauri M, Leonardi C, Melotti RM, Natoli S, Romualdi P, Savoia G, Corcione A. The challenge of perioperative pain management in opioid-tolerant patients. Ther Clin Risk Manag. 2017;13:1163–73.  https://doi.org/10.2147/TCRM.S141332.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Oksar M. Sedation for percutaneous endoscopic lumbar discectomy. ScientificWorldJournal. 2016;2016:8767410.CrossRefGoogle Scholar
  24. 24.
    Wang MY, Grossman J. Endoscopic minimally invasive transforaminal interbody fusion without general anesthesia: initial clinical experience with 1-year follow-up. Neurosurg Focus. 2016;40(2):E13.  https://doi.org/10.3171/2015.11.FOCUS15435.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Kim KH. Safe sedation and hypnosis using dexmedetomidine for minimally invasive spine surgery in a prone position. Korean J Pain. 2014;27(4):313–20.  https://doi.org/10.3344/kjp.2014.27.4.313.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Jellish WS, Shea JF. Spinal anaesthesia for spinal surgery. Best Pract Res Clin Anaesthesiol. 2003;17(3):323–34. ReviewCrossRefGoogle Scholar
  27. 27.
    Meng T, Zhong Z, Meng L. Impact of spinal anaesthesia vs. general anaesthesia on peri-operative outcome in lumbar spine surgery: a systematic review and meta-analysis of randomised, controlled trials. Anaesthesia. 2017;72(3):391–401.  https://doi.org/10.1111/anae.13702.CrossRefPubMedGoogle Scholar
  28. 28.
    Lessing NL, Edwards CC 2nd, Brown CH 4th, Ledford EC, Dean CL, Lin C, Edwards CC. Spinal anesthesia in elderly patients undergoing lumbar spine surgery. Orthopedics. 2017;40(2):e317–22.  https://doi.org/10.3928/01477447–20161219–01.CrossRefPubMedGoogle Scholar
  29. 29.
    De Rojas JO, Syre P, Welch WC. Regional anesthesia versus general anesthesia for surgery on the lumbar spine: a review of the modern literature. Clin Neurol Neurosurg. 2014;119:39–43.  https://doi.org/10.1016/j.clineuro.2014.01.016.CrossRefPubMedGoogle Scholar
  30. 30.
    Chen HT, Tsai CH, Chao SC, Kao TH, Chen YJ, Hsu HC, Shen CC, Tsou HK. Endoscopic discectomy of L5-S1 disc herniation via an interlaminar approach: prospective controlled study under local and general anesthesia. Surg Neurol Int. 2011;2:93.  https://doi.org/10.4103/2152–7806.82570.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Loftus RW, Yeager MP, Clark JA, Brown JR, Abdu WA, Sengupta DK, Beach ML. Intraoperative ketamine reduces perioperative opiate consumption in opiate-dependent patients with chronic back pain undergoing back surgery. Anesthesiology. 2010;113(3):639–46.  https://doi.org/10.1097/ALN.0b013e3181e90914.CrossRefPubMedGoogle Scholar
  32. 32.
    Kim KT, Cho DC, Sung JK, Kim YB, Kang H, Song KS, Choi GJ. Intraoperative systemic infusion of lidocaine reduces postoperative pain after lumbar surgery: a double-blinded, randomized, placebo-controlled clinical trial. Spine J. 2014;14(8):1559–66.  https://doi.org/10.1016/j.spinee.2013.09.031.CrossRefPubMedGoogle Scholar
  33. 33.
    Buvanendran A, Thillainathan V. Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine. Spine (Phila Pa 1976). 2010;35(26 Suppl):S274–80.  https://doi.org/10.1097/BRS.0b013e31820240f8.CrossRefGoogle Scholar
  34. 34.
    Verma V, Singh N, Singh Jaggi A. Pregabalin in neuropathic pain: evidences and possible mechanisms. Curr Neuropharmacol. 2014;12(1):44–56.  https://doi.org/10.2174/1570159X1201140117162802.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lam DM, Choi SW, Wong SS, Irwin MG, Cheung CW. Efficacy of pregabalin in acute postoperative pain under different surgical categories: a meta-analysis. Medicine (Baltimore). 2015;94(46):e1944.  https://doi.org/10.1097/MD.0000000000001944.CrossRefGoogle Scholar
  36. 36.
    Jiang HL, Huang S, Song J, Wang X, Cao ZS. Preoperative use of pregabalin for acute pain in spine surgery: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96(11):e6129.  https://doi.org/10.1097/MD.0000000000006129.CrossRefGoogle Scholar
  37. 37.
    Zarei M, Najafi A, Mansouri P, Sadeghi-Yazdankhah S, Saberi H, Moradi M, Farzan M. Management of postoperative pain after Lumbar surgery-pregabalin for one day and 14 days-a randomized, triple-blinded, placebo-controlled study. Clin Neurol Neurosurg. 2016;151:37–42.  https://doi.org/10.1016/j.clineuro.2016.10.007.CrossRefPubMedGoogle Scholar
  38. 38.
    Shimony N, Amit U, Minz B, Grossman R, Dany MA, Gonen L, Kandov K, Ram Z, Weinbroum AA. Perioperative pregabalin for reducing pain, analgesic consumption, and anxiety and enhancing sleep quality in elective neurosurgical patients: a prospective, randomized, double-blind, and controlled clinical study. J Neurosurg. 2016;125(6):1513–22.CrossRefGoogle Scholar
  39. 39.
    Rivkin A, Rivkin MA. Perioperative nonopioid agents for pain control in spinal surgery. Am J Health Syst Pharm. 2014;71(21):1845–57.  https://doi.org/10.2146/ajhp130688.CrossRefPubMedGoogle Scholar
  40. 40.
    Kobayashi H, Hasegawa Y, Ono H. Cyclobenzaprine, a centrally acting muscle relaxant, acts on descending serotonergic systems. Eur J Pharmacol. 1996;311(1):29–35.CrossRefGoogle Scholar
  41. 41.
    Singh K, Bohl DD, Ahn J, Massel DH, Mayo BC, Narain AS, Hijji FY, Louie PK, Long WW, Modi KD, Kim TD, Kudaravalli KT, Phillips FM, Buvanendran A. Multimodal analgesia versus intravenous patient-controlled analgesia For minimally invasive transforaminal lumbar interbody fusion procedures. Spine (Phila Pa 1976). 2017;42(15):1145–50.CrossRefGoogle Scholar
  42. 42.
    Miotto K, Cho AK, Khalil MA, Blanco K, Sasaki JD, Rawson R. Trends in tramadol: pharmacology, metabolism, and misuse. Anesth Analg. 2017;124(1):44–51.CrossRefGoogle Scholar
  43. 43.
    Bohl DD, Louie PK, Shah N, Mayo BC, Ahn J, Kim TD, Massel DH, Modi KD, Long WW, Buvanendran A, Singh K. Multimodal versus patient-controlled analgesia after an anterior cervical decompression and fusion. Spine (Phila Pa 1976). 2016;41(12):994–8.  https://doi.org/10.1097/BRS.0000000000001380.CrossRefGoogle Scholar
  44. 44.
    Chin KR, Sundram H, Marcotte P. Bleeding risk with ketorolac after lumbar microdiscectomy. J Spinal Disord Tech. 2007;20(2):123–6.CrossRefGoogle Scholar
  45. 45.
    Pradhan BB, Tatsumi RL, Gallina J, Kuhns CA, Wang JC, Dawson EG. Ketorolac and spinal fusion: does the perioperative use of ketorolac really inhibit spinal fusion? Spine (Phila Pa 1976). 2008;33(19):2079–82.  https://doi.org/10.1097/BRS.0b013e31818396f4.CrossRefGoogle Scholar
  46. 46.
    Sivaganesan A, Chotai S, White-Dzuro G, McGirt MJ, Devin CJ. The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies. Eur Spine J. 2017;  https://doi.org/10.1007/s00586–017–5021-y.
  47. 47.
    Kurd MF, Kreitz T, Schroeder G, Vaccaro AR. The role of multimodal analgesia in spine surgery. J Am Acad Orthop Surg. 2017;25(4):260–8.  https://doi.org/10.5435/JAAOS-D-16–00049.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, Zdeblick TA, Resnick DK. Comparison of perioperative oral multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech. 2010;23(2):139–45.  https://doi.org/10.1097/BSD.0b013e3181cf07ee.CrossRefPubMedGoogle Scholar
  49. 49.
    Hansen RN, Pham AT, Böing EA, Lovelace B, Wan GJ, Miller TE. Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen. Curr Med Res Opin. 2017;33(5):943–8.  https://doi.org/10.1080/03007995.2017.1297702.CrossRefPubMedGoogle Scholar
  50. 50.
    Anitescu M, Benzon HT, Argoff CE. Advances in topical analgesics. Curr Opin Anaesthesiol. 2013;26(5):555–61.  https://doi.org/10.1097/01.aco.0000432514.00446.22.CrossRefPubMedGoogle Scholar
  51. 51.
    Jorge LL, Feres CC, Teles VE. Topical preparations for pain relief: efficacy and patient adherence. J Pain Res. 2010;20(4):11–24.  https://doi.org/10.2147/JPR.S9492.CrossRefGoogle Scholar
  52. 52.
    Kim KH. Use of lidocaine patch for percutaneous endoscopic lumbar discectomy. Korean J Pain. 2011;24(2):74–80.  https://doi.org/10.3344/kjp.2011.24.2.74.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Kang H, Jung HJ, Lee JS, Yang JJ, Shin HY, Song KS. Early postoperative analgesic effects of a single epidural injection of ropivacaine administered preoperatively in posterior lumbar interbody spinal arthrodesis: a pilot randomized controlled trial. J Bone Joint Surg Am. 2013;95(5):393–9.  https://doi.org/10.2106/JBJS.K.01729.CrossRefPubMedGoogle Scholar
  54. 54.
    Park SY, An HS, Lee SH, Suh SW, Kim JL, Yoon SJ. A prospective randomized comparative study of postoperative pain control using an epidural catheter in patients undergoing posterior lumbar interbody fusion. Eur Spine J. 2016;25(5):1601–7.  https://doi.org/10.1007/s00586–016–4385–8.CrossRefPubMedGoogle Scholar
  55. 55.
    Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes. J Clin Neurosci. 2015;22(6):930–8.  https://doi.org/10.1016/j.jocn.2015.01.003.CrossRefPubMedPubMedCentralGoogle Scholar
  56. 56.
    Eckman WW, Hester L, McMillen M. Same-day discharge after minimally invasive transforaminal lumbar interbody fusion: a series of 808 cases. Clin Orthop Relat Res. 2014;472(6):1806–12.  https://doi.org/10.1007/s11999–013–3366-z.CrossRefPubMedGoogle Scholar
  57. 57.
    Santiago-Pérez S, Nevado-Estévez R, Aguirre-Arribas J, Pérez-Conde MC. Neurophysiological monitoring of lumbosacral spinal roots during spinal surgery: continuous intraoperative electromyography (EMG). Electromyogr Clin Neurophysiol. 2007;47(7–8):361–7.PubMedGoogle Scholar
  58. 58.
    Dilmen OK. Letter to the Editor: Intraoperative neurophysiological monitoring: an anesthesiologist’s point of view. Neurosurg Focus. 2016;41(3):E17.  https://doi.org/10.3171/2016.3.FOCUS16103.CrossRefPubMedGoogle Scholar
  59. 59.
    Gonzalez AA, Jeyanandarajan D, Hansen C, Zada G, Hsieh PC. Intraoperative neurophysiological monitoring during spine surgery: a review. Neurosurg Focus. 2009;27(4):E6.  https://doi.org/10.3171/2009.8.FOCUS09150.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Uribe JS, Vale FL, Dakwar E. Electromyographic monitoring and its anatomical implications in minimally invasive spine surgery. Spine (Phila Pa 1976). 2010;35(26 Suppl):S368–74.  https://doi.org/10.1097/BRS.0b013e3182027976.CrossRefGoogle Scholar
  61. 61.
    Lall RR, Lall RR, Hauptman JS, Munoz C, Cybulski GR, Koski T, Ganju A, Fessler RG, Smith ZA. Intraoperative neurophysiological monitoring in spine surgery: indications, efficacy, and role of the preoperative checklist. Neurosurg Focus. 2012;33(5):E10.  https://doi.org/10.3171/2012.9.FOCUS12235.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Ramesh M. Singa
    • 1
  • Asokumar Buvanendran
    • 1
  1. 1.Department of AnesthesiologyRush University Medical CenterChicagoUSA

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