Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

Terracina, S; Robba, Chiara; Prete, Anna Del; Sergi, P.; Bilotta, Federico

doi:10.1111/papr.12684

Cited by 17 publications

(7 citation statements)

References 85 publications

(239 reference statements)

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“…Furthermore, when compared to the PROSPECT recommendation of ESRA for pain management after open liver resection, new evidence has emerged about the efficacy of QLB, dexmedetomidine infusion, and few benefits in ITM utilization in these settings [20]. As with other subspecialty procedures, postoperative pain management should be addressed considering the specific evidence-based principles [60][61][62]. This SR now provides a detailed and comprehensive summary of specific clinical evidence targeted to postoperative analgesia in open liver surgery.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

Dudek

Zawadka

Andruszkiewicz

et al. 2021

JCM

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Background: The existing recommendations for after open liver surgery, published in 2019, contains limited evidence on the use of regional analgesia techniques. The aim of this systematic review is to summarize available clinical evidence, published after September 2013, on systemic or blended postoperative analgesia for the prevention or treatment of postoperative pain after open liver surgery. Methods: The PUBMED and EMBASE registries were used for the literature search to identify suitable studies. Keywords for the literature search were selected, with the authors’ agreement, using the PICOS approach: participants, interventions, comparisons, outcomes, and study design. Results: The literature search led to the retrieval of a total of 800 studies. A total of 36 studies including 25 RCTs, 5 prospective observational, and 7 retrospective observational studies were selected as suitable for this systematic review. Conclusions: The current evidence suggests that, in these patients, optimal postoperative pain management should rely on using a “blended approach” which includes the use of systemic opioids and the infusion of NSAIDs along with regional techniques. This approach warrants the highest efficacy in terms of pain prevention, including the lower incretion of postoperative “stress hormones”, and fewer side effects. Furthermore, concerns about the potential for the increased risk of wound infection related to the use of regional techniques have been ruled out.

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Section: Discussionmentioning

confidence: 99%

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

Dudek

Zawadka

Andruszkiewicz

et al. 2021

JCM

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“…For example, a growing body of evidence suggests that intraoperative and/or postoperative ketamine infusions are associated with decreased postoperative pain and reduced postoperative opiate consumption and may help to prevent opioid-induced hyperalgesia. [46][47][48][49] To this end, the use of a continuous postoperative ketamine infusion is being studied at our institution and may soon become incorporated into our ERASS protocol. 46 Lastly, the present study examined patients undergoing relatively uncomplicated spine surgeries (e.g., ACDFs and lumbar microdiscectomies) for degenerative cervical or lumbar pathologies; relatively few patients underwent posterior lumbar fusion (n = 5 in the ERASS group and n = 15 in the control group).…”

Section: Context Of the Present Workmentioning

confidence: 99%

Experience with an Enhanced Recovery After Spine Surgery protocol at an academic community hospital

Young¹,

Cottrill²,

Pennington³

et al. 2021

Journal of Neurosurgery: Spine

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OBJECTIVEEnhanced Recovery After Surgery (ERAS) protocols have rapidly gained popularity in multiple surgical specialties and are recognized for their potential to improve patient outcomes and decrease hospitalization costs. However, they have only recently been applied to spinal surgery. The goal in the present work was to describe the development, implementation, and impact of an Enhanced Recovery After Spine Surgery (ERASS) protocol for patients undergoing elective spine procedures at an academic community hospital.METHODSA multidisciplinary team, drawing on prior publications and spine surgery best practices, collaborated to develop an ERASS protocol. Patients undergoing elective cervical or lumbar procedures were prospectively enrolled at a single tertiary care center; interventions were standardized across the cohort for pre-, intra-, and postoperative care using standardized order sets in the electronic medical record. Protocol efficacy was evaluated by comparing enrolled patients to a historic cohort of age- and procedure-matched controls. The primary study outcomes were quantity of opiate use in morphine milligram equivalents (MMEs) on postoperative day (POD) 1 and length of stay. Secondary outcomes included frequency and duration of indwelling urinary catheter use, discharge disposition, 30-day readmission and reoperation rates, and complication rates. Multivariable linear regression was used to determine whether ERASS protocol use was independently predictive of opiate use on POD 1.RESULTSIn total, 97 patients were included in the study cohort and were compared with a historic cohort of 146 patients. The patients in the ERASS group had lower POD 1 opiate use than the control group (26 ± 33 vs 42 ± 40 MMEs, p < 0.001), driven largely by differences in opiate-naive patients (16 ± 21 vs 38 ± 36 MMEs, p < 0.001). Additionally, patients in the ERASS group had shorter hospitalizations than patients in the control group (51 ± 30 vs 62 ± 49 hours, p = 0.047). On multivariable regression, implementation of the ERASS protocol was independently predictive of lower POD 1 opiate consumption (β = −7.32, p < 0.001). There were no significant differences in any of the secondary outcomes.CONCLUSIONSThe authors found that the development and implementation of a comprehensive ERASS protocol led to a modest reduction in postoperative opiate consumption and hospital length of stay in patients undergoing elective cervical or lumbar procedures. As suggested by these results and those of other groups, the implementation of ERASS protocols may reduce care costs and improve patient outcomes after spine surgery.

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“…11,12 Tramadol mainly acts by inhibiting the reuptake of norepinephrine and serotonin and is widely considered a safe and effective intravenous analgesic. [13][14][15] Currently, the most commonly used first-line antidepressants for the treatment of depression are norepinephrine reuptake inhibitor and serotonin reuptake inhibitor, [16][17][18] and these are the choices for the treatment of anxiety disorder. 19 Therefore, it is significantly likely that tramadol can relieve depression and anxiety in women undergoing elective surgery under general anesthesia while providing postoperative analgesic effects.…”

Section: Introductionmentioning

confidence: 99%

Effects of Intravenous Analgesia Using Tramadol on Postoperative Depression State and Sleep Quality in Women Undergoing Abdominal Endoscopic Surgery: A Randomized Controlled Trial

Fu¹,

Chen²,

Xu³

et al. 2022

DDDT

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This study aimed to explore the effects of intravenous analgesia using tramadol on postoperative depression, anxiety, and sleep in women undergoing abdominal endoscopic surgery. Patients and Methods: Two hundred female patients (100 in each group) who underwent abdominal endoscopic surgery were recruited to randomly receive intravenous analgesia with sufentanil combined with tramadol (tramadol group) or sufentanil (control group). The primary outcome was the incidence of postoperative depression, which was assessed at 1, 2, and 3 days after surgery using the 13-item Beck Depression Inventory. The secondary outcomes were the incidence of anxiety and sleep quality, which were assessed using the 20-item Self-Rating Anxiety Scale and Richards-Campbell Sleep Questionnaire. Results: The incidence of depression (Beck depression scale≥4) during the 3-day follow-up in the control group was 51%, which was significantly higher than that in the tramadol group of 28% (relative risk [RR]=0.55; 95% confidence interval [CI], 0.38-0.79; P=0.001). No difference was found in the incidence of anxiety state (Self-Rating Anxiety Scale≥40) between the tramadol and control groups (7%vs 5%; RR=1.40; 95% CI, 0.46-4.25; P=0.552). All of the Richards-Campbell sleep scales of patients in the tramadol group at 1 (77.4±15.2 vs 64.2±20.1, P<0.001), 2 (84.1±14.9 vs 71.8±18.8, P<0.001), and 3 days (87.0±12.2 vs 70.3±21.0, P<0.001) after surgery were higher than those in the control group. Conclusion: Intravenous analgesia using tramadol can effectively improve the postoperative depression and sleep status of women undergoing abdominal endoscopic surgery. Tramadol is recommended for use in postoperative analgesia when improving postoperative mood, and sleep is needed in clinical practice.

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Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review

Cited by 17 publications

References 85 publications

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

Postoperative Analgesia after Open Liver Surgery: Systematic Review of Clinical Evidence

Experience with an Enhanced Recovery After Spine Surgery protocol at an academic community hospital

Effects of Intravenous Analgesia Using Tramadol on Postoperative Depression State and Sleep Quality in Women Undergoing Abdominal Endoscopic Surgery: A Randomized Controlled Trial

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