PAIN SYNDROME AND PAIN MANAGEMENT AFTER LUMBAR SPINE SURGERY

Abstract

Background. Multimodal analgesia (MMA) in spine surgery is in the beginning of implementation because of contradictions about the negative influence of NSAIDs on spinal fusion process. There is no agreement as to the influence of anesthesia method on postoperative pain after lumbar spine surgery. Aim of the study was to examine the influence of anesthesia type and postoperative pain management on narcotic consumption during lumbar spine surgery. Material and methods: 250 ASA I-II patients 18-65 y.o. during elective lumbar spine surgery on 1-2 segments were examined prospectively. Patients were divided into 4 groups: 1А (n=55) – spinal anesthesia (SA) and standard pain management, 1В (n=55) – SA and MMA, 2А (n=70) – intravenous anesthesia with propofol/fentanyl (TIVA) and standard pain management, 2В (n=70) – TIVA and ММА. Standard pain management included acetaminophen 1 g IV 3 times per day and morphine if VAS pain score was e” 4. For MMA we additionally included pregabalin 75 mg 12 hours before surgery and then two times per day during 3 days and parecoxib 40 mg IV twice per day for the first postoperative day. Results: in both MMA groups (1B and 2B) time of the first morphine requirement was significantly longer than in standard pain management groups (1A and 2A). Average dose of morphine during 24 postoperative hours was the biggest in 2A group (TIVA with standard pain management). In MMA patients the incidence of nausea was lower than in standard pain management patients. Dizziness occurred more frequently in TIVA patients with standard pain management. Conclusions: anesthesia type has an influence on the postoperative pain during the first 24 hours: the average morphine consumption is bigger in TIVA patients with standard pain management than in SA patients. MMA decreases narcotic consumption in any type of anesthesia and decreases postoperative nausea and dizziness