Abstract
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.
Highlights
IntroductionEffective pain management is one of cornerstones of enhanced recovery after surgery [1]
Effective pain management is one of cornerstones of enhanced recovery after surgery [1].It allows early mobilization and reduces rate of complications
Neuropathic pain was determined in 53,9 % of patients before surgery
Summary
Effective pain management is one of cornerstones of enhanced recovery after surgery [1]. It allows early mobilization and reduces rate of complications. Half of patients still suffer from moderate to severe postoperative pain [2] that can lead to hyperalgesia and chronic pain. Another reason of poorly treated pain in patients with lumbar spine diseases is its complex characteristics [3] and a significant influence of neuropathic component [4]. The influence of anesthesia type on postoperative pain after lumbar spine surgery is controversial [6, 7]
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