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Pain Management

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Lumbar Spine Access Surgery

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Abstract

Optimizing pain control in the perioperative, postoperative, and chronic settings of lumbar spine access surgery is a critical component of surgical care and may have a dramatic impact on patient outcomes. Despite advances in technologies, pain control after surgery remains difficult to manage adequately. Preventing the development of chronic pain states should be a priority for providers. Achieving adequate pain control postoperatively is associated with improved patient satisfaction rates, shorter hospital stays, and lower costs. The process begins as soon as a patient is admitted to the surgical care team. This chapter will assess the literature to determine effective regimens for surgeons to achieve satisfactory pain control outcomes. Previously, predominantly opioid-based pain management was standard due to low cost, though growing evidence shows significantly increased adverse effects, hospital costs, and poor long-term outcomes associated with opioid-based strategies. No single strategy has emerged as the “gold standard”; however, an increase in multimodal, nonopioid-based analgesia is a common trend for management. This chapter will discuss these strategies including newer developments and interventional approaches to potential surgical complications.

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References

  1. Vadivelu N, Mitra S, Narayan D. Recent advances in postoperative pain management. Yale J Biol Med. 2010;83(1):11.

    CAS  PubMed  PubMed Central  Google Scholar 

  2. Berardino K, Carroll AH, Kaneb A, Civilette MD, Sherman WF, Kaye AD. An update on postoperative opioid use and alternative pain control following spine surgery. Orthop Rev (Pavia). 2021;13(2):24978.

    Article  PubMed  Google Scholar 

  3. Garimella V, Cellini C. Postoperative pain control. Clin Colon Rectal Surg. 2013;26(3):191.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rosenblum A, Marsch LA, Joseph H, Portenoy RK. Opioids and the treatment of chronic pain: controversies, current status, and future directions. Exp Clin Psychopharmacol. 2008;16(5):405.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kehlet H, Dahl JB. The value of “multimodal” or “balanced analgesia” in postoperative pain treatment. Anesth Analg. 1993;77(5):1048–56.

    CAS  PubMed  Google Scholar 

  6. Lavand’homme P. Transition from acute to chronic pain after surgery. Pain. 2017;158(1):S50–4. https://doi.org/10.1097/j.pain.0000000000000809.

    Article  PubMed  Google Scholar 

  7. Singh SJ. Pain relief following spinal surgeries: a challenging task. J Spine. 2015;4:3. https://doi.org/10.4172/2165-7939.1000233.

    Article  Google Scholar 

  8. Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. J Spine Surg. 2019;5(Suppl 2):S154–9.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Simpson B, Christelis N, Russo M, Stanton-Hicks M, et al. Persistent spinal pain syndrome: a proposed replacement for failed back surgery syndrome. Br J Neurosurg. 2023;37(2):244.

    Article  PubMed  Google Scholar 

  10. Ounajim A, Billot M, Louis P-Y, Slaoui Y, et al. Finite mixture models based on pain intensity, functional disability and psychological distress composite assessment allow identification of two distinct classes of persistent spinal pain syndrome after surgery patients related to their quality of life. J Clin Med Res. 2021;10(20):4676. https://doi.org/10.3390/jcm10204676.

    Article  Google Scholar 

  11. Wall PD. The prevention of postoperative pain. Pain. 1988;33(3):289–90. https://doi.org/10.1016/0304-3959(88)90286-2.

    Article  CAS  PubMed  Google Scholar 

  12. Vadivelu N, Mitra S, Schermer E, Kodumudi V, et al. Preventive analgesia for postoperative pain control: a broader concept. Local Region Anesth. 2014;7:17–22.

    Google Scholar 

  13. Schnabel A, Yahiaoui-Doktor M, Meissner W, Zahn PK, Pogatzki-Zahn EM. Predicting poor postoperative acute pain outcome in adults: an international, multicentre database analysis of risk factors in 50,005 patients. Pain Rep. 2020;5(4):e831.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Woolf CJ, Chong MS. Preemptive analgesia—treating postoperative pain by preventing the establishment of central sensitization. Anesth Analg. 1993;77(2):362–79.

    Article  CAS  PubMed  Google Scholar 

  15. Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of preemptive analgesia for postoperative pain relief. Anesthesiology. 2002;96(3):725–41. https://doi.org/10.1097/00000542-200203000-00032.

    Article  PubMed  Google Scholar 

  16. Kim S-I, Ha K-Y, Oh I-S. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J. 2016;25(5):1614–9.

    Article  PubMed  Google Scholar 

  17. 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.

    Article  PubMed  Google Scholar 

  18. Dooley DJ, Taylor CP, Donevan S, Feltner D. Ca2+ channel alpha2delta ligands: novel modulators of neurotransmission. Trends Pharmacol Sci. 2007;28(2):75–82.

    Article  CAS  PubMed  Google Scholar 

  19. Li H, Xie W, Strong JA, Zhang J-M. Systemic antiinflammatory corticosteroid reduces mechanical pain behavior, sympathetic sprouting, and elevation of proinflammatory cytokines in a rat model of neuropathic pain. Anesthesiology. 2007;107(3):469–77.

    Article  CAS  PubMed  Google Scholar 

  20. Griffin CE III, Kaye AM, Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous system–mediated effects. Ochsner J. 2013;13(2):214.

    PubMed  PubMed Central  Google Scholar 

  21. PubChem. Methocarbamol. n.d. https://pubchem.ncbi.nlm.nih.gov/compound/4107. Accessed 8 Oct 2021.

  22. PubChem. Cyclobenzaprine. n.d. https://pubchem.ncbi.nlm.nih.gov/compound/2895. Accessed 8 Oct 2021.

  23. Cohen B, Ruth LJ, Preuss CV. Opioid analgesics StatPearls. Treasure Island: StatPearls Publishing; 2021.

    Google Scholar 

  24. CDC guideline for prescribing opioids for chronic pain. https://www.cdc.gov/drugoverdose/pdf/guidelines_at-a-glance-a.pdf#:~:text=nonopioid%20pharmacologic%20therapy%20are%20preferred%20for%20chronic%20pain.,nonpharmacologic%20therapy%20and%20nonopioid%20pharmacologic%20therapy%2C%20as%20appropriate. Accessed 5 Oct 2021.

  25. Crockett SD, Greer KB, Heidelbaugh JJ, Falck-Ytter Y, et al. American Gastroenterological Association Institute guideline on the medical management of opioid-induced constipation. Gastroenterology. 2019;156(1):218–26.

    Article  PubMed  Google Scholar 

  26. Smischney NJ, Pollard EM, Nookala AU, Olatoye OO. Serotonin syndrome in the perioperative setting. Am J Case Rep. 2018;19:833–5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Tully J, Jung JW, Patel A, Tukan A, et al. Utilization of intravenous lidocaine infusion for the treatment of refractory chronic pain. Anesth Pain Med. 2020;10(6):e112290.

    PubMed  Google Scholar 

  28. Anon. The role of sodium channels in neuropathic pain. Semin Cell Dev Biol. 2006;17(5):571–81.

    Article  Google Scholar 

  29. van der Wal SEI, van den Heuvel SAS, Radema SA, van Berkum BFM, et al. The in vitro mechanisms and in vivo efficacy of intravenous lidocaine on the neuroinflammatory response in acute and chronic pain. Eur J Pain. 2016;20(5):655–74.

    Article  PubMed  Google Scholar 

  30. Park CH, Jung SH, Han CG. Effect of intravenous lidocaine on the neuropathic pain of failed back surgery syndrome. Korean J Pain. 2012;25(2):94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Kandil E, Melikman E, Adinoff B. Lidocaine infusion: a promising therapeutic approach for chronic pain. J Anesth Clin Res. 2017;8(1):697.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dale O, Somogyi AA, Li Y, Sullivan T, Shavit Y. Does intraoperative ketamine attenuate inflammatory reactivity following surgery? A systematic review and meta-analysis. Anesth Analg. 2012;115(4):934–43.

    Article  CAS  PubMed  Google Scholar 

  33. Bell RF, Kalso EA. Ketamine for pain management. Pain Rep. 2018;3(5):e674.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Brinck EC, Tiippana E, Heesen M, Bell RF, et al. Perioperative intravenous ketamine for acute postoperative pain in adults. Cochrane Database Syst Rev. 2018;12(12):CD012033.

    PubMed  Google Scholar 

  35. Nielsen RV. Adjuvant analgesics for spine surgery. Dan Med J. 2018;65(3):B5468.

    PubMed  Google Scholar 

  36. Pendi A, Field R, Farhan S-D, Eichler M, Samuel BS. Perioperative ketamine for analgesia in spine surgery: a meta-analysis of randomized controlled trials. Spine. 2018;43(5):E299.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Bell RF, Dahl JB, Andrew Moore R, Kalso EA. Perioperative ketamine for acute postoperative pain. Cochrane Database Syst Rev. 2006;12(1):CD004603.

    Google Scholar 

  38. Anon. Non-opioid analgesics: novel approaches to perioperative analgesia for major spine surgery. Best Pract Res Clin Anaesth. 2016;30(1):79–89.

    Article  Google Scholar 

  39. Peng Y-N, Sung F-C, Huang M-L, Lin C-L, Kao C-H. The use of intravenous magnesium sulfate on postoperative analgesia in orthopedic surgery: a systematic review of randomized controlled trials. Medicine. 2018;97(50):e13583.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Yue L, Lin Z, Mu G, Sun H. Impact of intraoperative intravenous magnesium on spine surgery: a systematic review and meta-analysis of randomized controlled trials. EClinicalMedicine. 2022;43:101246.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Moharari RS, Motalebi M, Najafi A, Zamani MM, et al. Magnesium can decrease postoperative physiological ileus and postoperative pain in major non laparoscopic gastrointestinal surgeries: a randomized controlled trial. Anesth Pain Med. 2014;4(1):e12750.

    Google Scholar 

  42. Ghaffaripour S, Mahmoudi H, Eghbal H, Rahimi A. The effect of intravenous magnesium sulfate on post-operative analgesia during laminectomy. Cureus. 2016;8(6):e626.

    PubMed  PubMed Central  Google Scholar 

  43. Naik BI, Nemergut EC, Kazemi A, Fernández L, et al. The effect of dexmedetomidine on postoperative opioid consumption and pain after major spine surgery. Anesth Analg. 2016;122:5.

    Article  Google Scholar 

  44. Garg N, Panda NB, Gandhi KA, Bhagat H, et al. Comparison of small dose ketamine and dexmedetomidine infusion for postoperative analgesia in spine surgery—a prospective randomized double-blind placebo controlled study. J Neurosurg Anesthesiol. 2016;28(1):27–31. https://doi.org/10.1097/ANA.0000000000000193.

    Article  PubMed  Google Scholar 

  45. Tsaousi GG, Pourzitaki C, Aloisio S, Bilotta F. Dexmedetomidine as a sedative and analgesic adjuvant in spine surgery: a systematic review and meta-analysis of randomized controlled trials. Eur J Clin Pharmacol. 2018;74(11):1377–89.

    Article  CAS  PubMed  Google Scholar 

  46. Anon. Single injection Quadratus Lumborum block for postoperative analgesia in adult surgical population: a systematic review and meta-analysis. J Clin Anesth. 2020;62:109715.

    Article  Google Scholar 

  47. Uppal V, Retter S, Kehoe E, McKeen DM. Quadratus lumborum block for postoperative analgesia: a systematic review and meta-analysis. Can J Anesth. 2020;67(11):1557–75.

    Article  PubMed  Google Scholar 

  48. Wilton J, Chiu H, Codianne N, Knapp H, et al. Continuous quadratus lumborum block as post-operative strategy for pain control in spinal fusion surgery. Indian J Anaesth. 2020;64(10):869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Tsai H-C, Yoshida T, Chuang T-Y, Yang S-F, et al. Transversus abdominis plane block: an updated review of anatomy and techniques. Biomed Res Int. 2017;2017:8284363.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Viscusi ER. Emerging techniques in the management of acute pain: epidural analgesia. Anesth Analg. 2005;101(5 Suppl):S23–9.

    Article  PubMed  Google Scholar 

  51. Mobbs RJ, Phan K, Malham G, Seex K, Rao PJ. Lumbar interbody fusion: techniques, indications and comparison of interbody fusion options including PLIF, TLIF, MI-TLIF, OLIF/ATP, LLIF and ALIF. J Spine Surg. 2015;1(1):2–18.

    PubMed  PubMed Central  Google Scholar 

  52. Choy W, Barrington N, Garcia RM, Kim RB, et al. Risk factors for medical and surgical complications following single-level ALIF. Global Spine J. 2017;7(2):141–7.

    Article  PubMed  PubMed Central  Google Scholar 

  53. Epstein NE. Review of risks and complications of Extreme Lateral Interbody Fusion (XLIF). Surg Neurol Int. 2019;10:237.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Clarke H, Katz J, Flor H, Rietschel M, et al. Genetics of chronic post-surgical pain: a crucial step toward personal pain medicine. Can J Anaesth. 2015;62(3):294–303.

    Article  PubMed  Google Scholar 

  55. Liu H, Yue L, Chen SL, Hu B, et al. Anterior cervical discectomy and fusion to treat cervical spondylosis with sympathetic symptoms. Beijing Da Xue Xue Bao Yi Xue Ban. 2018;50(2):347–51.

    CAS  PubMed  Google Scholar 

  56. Wylde V, Dennis J, Beswick AD, Bruce J, et al. Systematic review of management of chronic pain after surgery. Br J Surg. 2017;104(10):1293–306.

    Article  CAS  PubMed  Google Scholar 

  57. Caylor J, Reddy R, Yin S, Cui C, et al. Spinal cord stimulation in chronic pain: evidence and theory for mechanisms of action. Bioelectron Medi. 2019;5:12. https://doi.org/10.1186/s42234-019-0023-1.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Rehabilitation Medicine, MedStar Georgetown University, Washington, DC, USA

    Nirguna Thalla & Andrew Wondra

  2. MedStar National Rehabilitation Hospital, Physical Medicine and Rehabilitation, Washington, DC, USA

    Nirguna Thalla & Andrew Wondra

  3. International Spine, Pain & Performance Center, Washington, DC, USA

    Mehul J. Desai

  4. School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA

    Mehul J. Desai

Authors
  1. Nirguna Thalla
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  2. Andrew Wondra
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  3. Mehul J. Desai
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Corresponding author

Correspondence to Mehul J. Desai .

Editor information

Editors and Affiliations

  1. Aligned Orthopaedics, Bethesda, MD, USA

    Joseph R. O'Brien

  2. Department of Orthopedic Surgery, The George Washington University, Washington, DC, USA

    Jeffrey B. Weinreb

  3. Vascular Surgery, Inova Health System, Falls Church, VA, USA

    Joseph C. Babrowicz

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Thalla, N., Wondra, A., Desai, M.J. (2023). Pain Management. In: O'Brien, J.R., Weinreb, J.B., Babrowicz, J.C. (eds) Lumbar Spine Access Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-48034-8_19

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  • DOI: https://doi.org/10.1007/978-3-031-48034-8_19

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  • Print ISBN: 978-3-031-48033-1

  • Online ISBN: 978-3-031-48034-8

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