Abstract
PurposeWith lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy.MethodsA systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020—assessing post-operative pain using analgesic, anaesthetic and surgical interventions—were identified from MEDLINE, EMBASE and Cochrane Databases.ResultsOut of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)—2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions—gabapentinoids and intrathecal opioid administration—although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence.ConclusionPerioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.
Highlights
Lumbar laminectomy is commonly performed in patients with lumbar spinal stenosis to relieve low back pain, reduce radiculopathy and improve overall function
Search terms related to pain and interventions for laminectomy AND pain OR pains OR pain management OR postoperative pain OR post-operative pain OR analgesia* OR anaesthesia* OR vas OR visual analogue* OR vrs OR verbal rating scale* OR nrs OR numerical rating scale* OR pain rating OR epidural OR neuraxial OR intrathecal OR paravertebral OR spinal OR infiltration OR nerve block* OR neural block* OR paravertebral block* OR field block* OR Ilioinguinal block* OR transversus abdominis plane block* OR tap block* OR non-steroidal anti-inflammatory drug (NSAID)* OR non-steroidal anti-inflammatory* OR non-steroidal anti-inflammatory* OR COX-2 OR Paracetamol OR acetaminophen OR clonidine OR opioid* OR ketamine OR corticosteroid* OR gabapentin OR pregabalin
A systematic review of the literature associated with analgesia after lumbar laminectomy was conducted in accordance with the PROSPECT methodology [9]
Summary
Lumbar laminectomy is commonly performed in patients with lumbar spinal stenosis to relieve low back pain, reduce radiculopathy and improve overall function. European Spine Journal (2021) 30:2925–2935 procedures are increasingly performed in an ambulatory or day-care setting. Inadequate pain management is one of the main reasons for delayed discharge or readmission after surgery [1, 4]. Effective pain control improves post-operative outcomes and patient satisfaction. Multimodal analgesia has frequently been recommended for enhanced recovery after surgery [5]. A lack of procedure-specific recommendations has resulted in heavy reliance on opioid medications [6]. Efforts to reduce opioid consumption and their associated adverse effects have been recently promoted [7]
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