EVALUATION OF PAIN SYNDROME AND EFFICIENCY OF PAIN MANAGEMENT IN LUMBAR SPINE SURGERY
Multimodal analgesia for lumbar spine surgery is still a controversial problem, because of possible fusion problems, significant neuropathic component of pain, and influence of anesthesia type. Aim of the study was to assess the efficacy of pain management after lumbar spine surgery considering characteristics of pain, type of anesthesia and analgesic regimen.
Material and methods. 254 ASA I-II patients with degenerative lumbar spine disease were enrolled into prospective study. Patients were operated either under spinal anesthesia (SA) or total intravenous anesthesia (TIVA). In postoperative period patients got either standard pain management (SPM – paracetamol±morphine) or multimodal analgesia (MMA – paracetamol+parecoxib+pregabalin±morphine).
Results. We revealed neuropathic pain in 53.9 % of patients, who were elected for lumbar spine surgery. VAS pain score in patients with neuropathic pain was higher, than in patients with nociceptive pain. Total intravenous anesthesia was associated with greater opioid consumption during the first postoperative day. Multimodal analgesia based on paracetamol, parecoxib and pregabalin allowed to decrease requirements for opioids, postoperative nausea and dizziness. Pregabalin used for evening premedication had equipotential anxiolytic effect as phenazepam without postoperative cognitive disturbances.
Conclusions. Multimodal analgesia is opioid-sparing technique that allows to decrease complications. Spinal anesthesia is associated to a decreased opioid consumption in the 1st postoperative day.
Ljungqvist, O., Hubner, M. (2018). Enhanced recovery after surgery – ERAS – principles, practice and feasibility in the elderly. Aging Clinical and Experimental Research, 30 (3), 249–252. doi: http://doi.org/10.1007/s40520-018-0905-1
Malik, O. S., Kaye, A. D., Urman, R. D. (2017). Perioperative Hyperalgesia and Associated Clinical Factors. Current Pain and Headache Reports, 21 (1). doi: http://doi.org/10.1007/s11916-017-0602-3
Maher, C., Underwood, M., Buchbinder, R. (2017). Non-specific low back pain. The Lancet, 389 (10070), 736–747. doi: http://doi.org/10.1016/s0140-6736(16)30970-9
Samuel, N., Bernstein, M., Alotaibi, N. M., Kalia, S. K., Shamji, M. F. (2016). Patient Perspectives Regarding Ethics of Spinal Column Stimulators in the Surgical Management of Persistent Postoperative Neuropathic Pain. Neuromodulation: Technology at the Neural Interface, 20 (3), 274–278. doi: http://doi.org/10.1111/ner.12470
Kurd, M. F., Kreitz, T., Schroeder, G., Vaccaro, A. R. (2017). The Role of Multimodal Analgesia in Spine Surgery. Journal of the American Academy of Orthopaedic Surgeons, 25 (4), 260–268. doi: http://doi.org/10.5435/jaaos-d-16-00049
Zorrilla-Vaca, A., Healy, R. J., Mirski, M. A. (2017). A Comparison of Regional Versus General Anesthesia for Lumbar Spine Surgery. Journal of Neurosurgical Anesthesiology, 29 (4), 415–425. doi: http://doi.org/10.1097/ana.0000000000000362
Meng, T., Zhong, Z., Meng, L. (2016). 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, 72 (3), 391–401. doi: http://doi.org/10.1111/anae.13702
Eckeli, F. D., Teixeira, R. A., Gouvêa, Á. L. (2016). Neuropathic pain evaluation tools. Revista Dor, 17. doi: http://doi.org/10.5935/1806-0013.20160041
Eckenhoff, R., Laudansky, K. (2013). Anesthesia, Surgery, Illness and Alzheimer’s Disease. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 47, 162–166. doi: http://doi.org/10.1016/j.pnpbp.2012.06.011
Rundshagen, I. (2014). Postoperative Cognitive Dysfunction. Deutsches Aerzteblatt Online, 111 (8), 119–125. doi: http://doi.org/10.3238/arztebl.2014.0119
Kim, K. H., Moon, S.-H., Hwang, C.-J., Cho, Y. E. (2015). Prevalence of Neuropathic Pain in Patients Scheduled for Lumbar Spine Surgery: Nationwide, Multicenter, Prospective Study. Pain Physician, 18, 889–897.
Isaikin, A. I., Isaikina, O. Y., Shadyzheva, T. I., Shor, Y. M., Kachanovsky, M. S. (2019). Back pain and osteoporosis. Neurology, Neuropsychiatry, Psychosomatics, 11 (3), 63–68. doi: http://doi.org/10.14412/2074-2711-2019-3-63-68
Yamashita, T., Takahashi, K., Yonenobu, K., Kikuchi, S. (2014). Prevalence of neuropathic pain in cases with chronic pain related to spinal disorders. Journal of Orthopaedic Science, 19 (1), 15–21. doi: http://doi.org/10.1007/s00776-013-0496-9
Raja S., D. C., Shetty, A. P., Subramanian, B., Kanna, R. M., Rajasekaran, S. (2019). A prospective randomized study to analyze the efficacy of balanced pre-emptive analgesia in spine surgery. The Spine Journal, 19 (4), 569–577. doi: http://doi.org/10.1016/j.spinee.2018.10.010
Bajwa, S. J., Haldar, R. (2015). Pain management following spinal surgeries: An appraisal of the available options. Journal of Craniovertebral Junction and Spine, 6 (3), 105–110. doi: http://doi.org/10.4103/0974-8237.161589
Sivaganesan, A., Chotai, S., White-Dzuro, G., McGirt, M. J., Devin, C. J. (2017). The effect of NSAIDs on spinal fusion: a cross-disciplinary review of biochemical, animal, and human studies. European Spine Journal, 26 (11), 2719–2728. doi: http://doi.org/10.1007/s00586-017-5021-y
Jiang, H., Huang, S., Song, J., Wang, X., Cao, Z. (2017). Preoperative use of pregabalin for acute pain in spine surgery A meta-analysis of randomized controlled trials. Medicine, 96 (11), e6129. doi: http://doi.org/10.1097/md.0000000000006129
Canos, A., Cort, L., Fernández, Y., Rovira, V., Pallarés, J., Barberá, M., Morales-Suárez-Varela, M. (2016). Preventive Analgesia with Pregabalin in Neuropathic Pain from “Failed Back Surgery Syndrome”: Assessment of Sleep Quality and Disability. Pain Medicine, 17 (2), 344–352. doi: http://doi.org/10.1111/pme.12895
Yadav, J., Singh, D., Jamuda, B., Singh, P. (2019). Oral pregabalin as premedication on anxiolysis and stress response to laryngoscopy and endotracheal intubation in patients undergoing laparoscopic cholecystectomy: A randomized double-blind study. Anesthesia: Essays and Researches, 13 (1), 97–104. doi: http://doi.org/10.4103/aer.aer_12_19
Shimony, N., Amit, U., Minz, B., Grossman, R., Dany, M. A., Gonen, L. et. al. (2016). 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. Journal of Neurosurgery, 125 (6), 1513–1522. doi: http://doi.org/10.3171/2015.10.jns151516
Copyright (c) 2019 Mykola Lyzohub, Marine Georgiyants, Kseniia Lyzohub
This work is licensed under a Creative Commons Attribution 4.0 International License.
Our journal abides by the Creative Commons CC BY copyright rights and permissions for open access journals.
Authors, who are published in this journal, agree to the following conditions:
1. The authors reserve the right to authorship of the work and pass the first publication right of this work to the journal under the terms of a Creative Commons CC BY, which allows others to freely distribute the published research with the obligatory reference to the authors of the original work and the first publication of the work in this journal.
2. The authors have the right to conclude separate supplement agreements that relate to non-exclusive work distribution in the form in which it has been published by the journal (for example, to upload the work to the online storage of the journal or publish it as part of a monograph), provided that the reference to the first publication of the work in this journal is included.