Pain Scores and Analgesic Therapy for Complex Spine Surgery in Tertiary Care Center

Abstract

Background: Complex spine surgery is an extensive operation with severe pain. At Siriraj Hospital, multimodal analgesia has been used, but it is not clear whether this technique provides adequate analgesia for major spine surgery. Objective: To assess the incidence and related factors of severe pain in patients undergoing complex spine surgery. Materials and Methods: A prospective, descriptive, observational study was conducted on adult patients undergoing complex thoracolumbar spine surgery at Siriraj Hospital between September 2016 and November 2018. The authors collected the patient demographic data, surgical data, perioperative pain management, and postoperative pain scores at rest and in movement. The data were analyzed using descriptive statistics, and the related factors to postoperative pain severity were analyzed using logistic regression analyses. Results: The present study enrolled 195 adults with a mean age of 61 years. Most were female (67.7%). The main diagnosis was spinal stenosis (38.5%). The procedures were laminectomies with posterior instrumentation (54.4%) and posterior instrumentation with interbody fusion (40.4%). The incidences of postoperative severe pain, a numeric pain rating scale score of more than 7 at rest/movement, at the PACU and at 4, 8, 12, 16, 20, 24, and 48 hours were 37.4%/47.2%, 33.3%/48.7%, 25.6%/39.0%, 17.4%/34.4%, 13.8%/31.3%, 11.8%/24.6%, 10.3%/24.6%, and 8.7%/15.9%, respectively. The overall incidence of postoperative severe pain was 35.4%. No relationships were established between the patient and the surgical factors. The related factors were intraoperative ketamine administration and severe pain in the recovery room. Conclusion: The incidence of severe pain remained high despite multimodal analgesia. There is room for improvement. Keywords: Complex spine surgery; Postoperative pain; Multimodal analgesia; Pain management