Skip to main content

Acute Pain Management Protocol for Spine Procedures

  • Chapter
  • First Online:
First Aid Perioperative Ultrasound

Abstract

The total number of spine surgeries performed has seen an upward trend over the past several decades not only in the United States but worldwide. Spine surgery is associated with moderate to severe postoperative pain and inadequate analgesia in patients undergoing spine surgery results in poor outcomes, delayed mobilization and rehabilitation, higher rates of admission and poor satisfaction. Although majority of lumbar spine procedures are still performed under general anesthesia, there is a large body of evidence that supports the use of regional interventions. Opportunities for regional anesthesia and analgesia have expanded recently due to emphasis on the opioid-minimizing approach for spine care (Table 1). Both neuraxial and truncal analgesia techniques have been tried, including epidural analgesic, spinal anesthesia, erector spinae plane blocks and thoracolumbar inter-fascial plane blocks. All these techniques work to control pain by different mechanisms and offer enhanced analgesia for a longer duration with lower dosage and side effects compared with administration of systemic opioids. In this chapter we will discuss regional analgesic approaches to manage pain after spine surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Dunn LK, Yerra S, Fang S, Hanak MF, Leibowitz MK, Tsang S, et al. Incidence and risk factors for chronic postoperative opioid use after major spine surgery: a cross-sectional study with longitudinal outcome. Anesth Analg. 2018;127(1):247–54.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Kowalski C, Ridenour R, McNutt S, Ba D, Liu G, Bible J, et al. Risk factors for prolonged opioid use after spine surgery. Global Spine J. 2021:21925682211003854.

    Google Scholar 

  3. Lawal OD, Gold J, Murthy A, Ruchi R, Bavry E, Hume AL, et al. Rate and risk factors associated with prolonged opioid use after surgery: a systematic review and meta-analysis. JAMA Netw Open. 2020;3(6):e207367.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zorrilla-Vaca A, Healy RJ, Mirski MA. A comparison of regional versus general anesthesia for lumbar spine surgery: a meta-analysis of randomized studies. J Neurosurg Anesthesiol. 2017;29(4):415–25.

    Article  PubMed  Google Scholar 

  5. Kaushal A, Haldar R. Regional anesthesia in neuroanesthesia practice. Discoveries (Craiova). 2020;8(2):e111.

    Article  PubMed  Google Scholar 

  6. Jellish WS, Shea JF. Spinal anaesthesia for spinal surgery. Best Pract Res Clin Anaesthesiol. 2003;17(3):323–34.

    Article  PubMed  Google Scholar 

  7. Xu T, Tian R, Qiao P, Han Z, Shen Q, Jia Y. Application of continuous epidural anesthesia in transforaminal lumbar endoscopic surgery: a prospective randomized controlled trial. J Int Med Res. 2019;47(3):1146–53.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Poblete B, Konrad C, Kothbauer KF. Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery. J Neurosurg Spine. 2014;21(6):899–904.

    Article  PubMed  Google Scholar 

  9. Zhang TJ, Zhang JJ, Qu ZY, Zhang HY, Qiu Y, Hua Z. Bilateral Erector Spinae Plane Blocks for Open Posterior Lumbar Surgery. J Pain Res. 2020;13:709–17.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ye Y, Bi Y, Ma J, Liu B. Thoracolumbar interfascial plane block for postoperative analgesia in spine surgery: a systematic review and meta-analysis. PLoS One. 2021;16(5):e0251980.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Wang H, Ma L, Yang D, Wang T, Wang Q, Zhang L, et al. Cervical plexus anesthesia versus general anesthesia for anterior cervical discectomy and fusion surgery: a randomized clinical trial. Medicine (Baltimore). 2017;96(7):e6119.

    Article  CAS  PubMed  Google Scholar 

  12. 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.

    Article  CAS  PubMed  Google Scholar 

  13. Benyahia NM, Verster A, Saldien V, Breebaart M, Sermeus L, Vercauteren M. Regional anaesthesia and postoperative analgesia techniques for spine surgery - a review. Rom J Anaesth Intensive Care. 2015;22(1):25–33.

    PubMed  PubMed Central  Google Scholar 

  14. Attari MA, Mirhosseini SA, Honarmand A, Safavi MR. Spinal anesthesia versus general anesthesia for elective lumbar spine surgery: a randomized clinical trial. J Res Med Sci. 2011;16(4):524–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Rusch D, Eberhart LH, Wallenborn J, Kranke P. Nausea and vomiting after surgery under general anesthesia: an evidence-based review concerning risk assessment, prevention, and treatment. Dtsch Arztebl Int. 2010;107(42):733–41.

    PubMed  PubMed Central  Google Scholar 

  16. Bhatia A, Buvanendran A. Anesthesia and postoperative pain control-multimodal anesthesia protocol. J Spine Surg. 2019;5(Suppl 2):S160–S5.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Berger M, Nadler JW, Browndyke J, Terrando N, Ponnusamy V, Cohen HJ, et al. Postoperative cognitive dysfunction: minding the gaps in our knowledge of a common postoperative complication in the elderly. Anesthesiol Clin. 2015;33(3):517–50.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Kim J, Shim JK, Song JW, Kim EK, Kwak YL. Postoperative cognitive dysfunction and the change of regional cerebral oxygen saturation in elderly patients undergoing spinal surgery. Anesth Analg. 2016;123(2):436–44.

    Article  PubMed  Google Scholar 

  19. Tetzlaff JE, Dilger JA, Kodsy M, Al-Bataineh J, Yoon HJ, Bell GR. Spinal anesthesia for elective lumbar spine surgery. J Clin Anesth. 1998;10(8):666–9.

    Article  CAS  PubMed  Google Scholar 

  20. Patil H, Garg N, Navakar D, Banabokade L. Lumbar spine surgeries under spinal anesthesia in high-risk patients: a retrospective analysis. World Neurosurg. 2019;124:e779.

    Article  Google Scholar 

  21. Hofhuizen C, Lemson J, Snoeck M, Scheffer GJ. Spinal anesthesia-induced hypotension is caused by a decrease in stroke volume in elderly patients. Local Reg Anesth. 2019;12:19–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Choi S, Mahon P, Awad IT. Neuraxial anesthesia and bladder dysfunction in the perioperative period: a systematic review. Can J Anaesth. 2012;59(7):681–703.

    Article  PubMed  Google Scholar 

  23. Ueshima H, Hara E, Otake H. Thoracolumbar interfascial plane block provides effective perioperative pain relief for patients undergoing lumbar spinal surgery; a prospective, randomized and double blinded trial. J Clin Anesth. 2019;58:12–7.

    Article  PubMed  Google Scholar 

  24. Liang X, Zhou W, Fan Y. Erector spinae plane block for spinal surgery: a systematic review and meta-analysis. Korean J Pain. 2021;34(4):487–500.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Singh S, Choudhary NK, Lalin D, Verma VK. Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in lumbar spine surgery: a randomized control trial. J Neurosurg Anesthesiol. 2020;32(4):330–4.

    Article  PubMed  Google Scholar 

  26. van den Broek RJC, van de Geer R, Schepel NC, Liu WY, Bouwman RA, Versyck B. Evaluation of adding the Erector spinae plane block to standard anesthetic care in patients undergoing posterior lumbar interbody fusion surgery. Sci Rep. 2021;11(1):7631.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Hillen Cruz Eng M, Ki Jinn Chin M, Fanzca BS, Sanjib D, Adhikary M. How I do it: erector spinae block for rib fractures: the Penn State Health Experience. 2020.

    Google Scholar 

  28. Hamilton DL, Manickam B. Erector spinae plane block for pain relief in rib fractures. Br J Anaesth. 2017;118(3):474–5.

    Article  CAS  PubMed  Google Scholar 

  29. Forero M, Adhikary SD, Lopez H, Tsui C, Chin KJ. The erector spinae plane block: a novel analgesic technique in thoracic neuropathic pain. Reg Anesth Pain Med. 2016;41(5):621–7.

    Article  CAS  Google Scholar 

  30. Selvi O, Tulgar S. Ultrasound guided erector spinae plane block as a cause of unintended motor block. Rev Esp Anestesiol Reanim (Engl Ed). 2018;65(10):589–92.

    Article  CAS  PubMed  Google Scholar 

  31. Melvin JP, Schrot RJ, Chu GM, Chin KJ. Low thoracic erector spinae plane block for perioperative analgesia in lumbosacral spine surgery: a case series. Can J Anaesth. 2018;65(9):1057–65.

    Article  PubMed  Google Scholar 

  32. Krishnan S, Cascella M. Erector spinae plane block. Treasure Island, FL: StatPearls Publishing; 2021.

    Google Scholar 

  33. Nicholas Snels BR, Malla U, Mitchell A, Abi-Fares C, Basson W, Chris Anstey LW. Optimising erector spinae block local anesthetic loading dose: a comparison of ropivicaine concentrations. J Emerg Crit Care Med. 2020;4:37.

    Article  Google Scholar 

  34. Kashani HH, Grocott HP. Clarity needed as to the optimal dose and volume of local anesthetic for erector spinae plane blockade for posterior rib fractures. Am J Emerg Med. 2018;36(6):1102–3.

    Article  PubMed  Google Scholar 

  35. Spivak A, Xu JL. Ultrasound guided paraspinal intrafascial plane blocks for postoperative analgesic on spine surgery. J Spine Surg. 2019;5(4):601–2.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Cheema SP, Ilsley D, Richardson J, Sabanathan S. A thermographic study of paravertebral analgesia. Anaesthesia. 1995;50(2):118–21.

    Article  CAS  PubMed  Google Scholar 

  37. Mavarez AC, Ahmed AA. Transabdominal plane block. Treasure Island, FL: StatPearls Publishing; 2021.

    Google Scholar 

  38. Soffin EM, Freeman C, Hughes AP, Wetmore DS, Memtsoudis SG, Girardi FP, et al. Effects of a multimodal analgesic pathway with transversus abdominis plane block for lumbar spine fusion: a prospective feasibility trial. Eur Spine J. 2019;28(9):2077–86.

    Article  PubMed  Google Scholar 

  39. Abdallah FW, Chan VW, Brull R. Transversus abdominis plane block: a systematic review. Reg Anesth Pain Med. 2012;37(2):193–209.

    Article  CAS  PubMed  Google Scholar 

  40. Ohgoshi Y, Izawa H, Kori S, Matsukawa M. Multifidus cervicis plane block is effective for cervical spine surgery. Can J Anaesth. 2017;64(3):329–30.

    Article  PubMed  Google Scholar 

  41. Ohgoshi Y, Nishizakura R, Takahashi Y, Takeda K, Nakayama H, Kawamata M, et al. Novel ultrasound-guided inter-semispinal plane block: a comparative pilot study in healthy volunteers. J Anesth. 2018;32(1):143–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sonal Sharma .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Mardini, J., Ramedani, S., Sharma, S. (2023). Acute Pain Management Protocol for Spine Procedures. In: Li, J., Jiang, W., Vadivelu, N. (eds) First Aid Perioperative Ultrasound. Springer, Cham. https://doi.org/10.1007/978-3-031-21291-8_34

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-21291-8_34

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-21290-1

  • Online ISBN: 978-3-031-21291-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics