Recent advances of multimodal analgesia in spinal surgery
10.3760/cma.j.issn.0253-2352.2019.12.007
- VernacularTitle: 脊柱手术多模式镇痛的应用进展
- Author:
Jin XU
1
;
Xinlong MA
Author Information
1. Tianjin hospital, Tianjin 300211, China
- Publication Type:Review
- From:
Chinese Journal of Orthopaedics
2019;39(12):774-780
- CountryChina
- Language:Chinese
-
Abstract:
Optical postoperative analgesia can improve patient mobility, reduce the incidence of complications, and im-prove patient satisfaction, while reducing hospital stays and costs. Early postoperative analgesia mainly depends on the opioids. In recent years, multimodal analgesia (MMA) program has been developed rapidly, which can significantly reduce the use of opioids and related adverse reactions. MMA in spinal surgery mainly includes advanced analgesia, non-steroidal anti-inflammatory drugs, neuromodulation drugs, acetaminophen drugs, intrathecal block and local expanded anesthesia. Current studies show that selective non-steroidal anti-inflammatory drugs or short-term, low-dose non-selective non-steroidal anti-inflammatory drugs do not affect postoperative spinal fusion; Neuromodulators can alleviate pain and reduce opioid use, while without significant adverse effects; Acetaminophen is the basis for different analgesia regimens after spinal surgery; In addition, level I evidence suggests that intrathe-cal block after lumbar discectomy can improve short-term pain and neurological symptoms of patients; Some studies suggest that local expanded anesthesia can reduce the use of other analgesics after spinal surgery. A growing of evidence supports the use of ad-vanced MMA regimens to control postoperative pain in patients undergoing spinal surgery, but further high-quality studies are needed to determine the optimal agent, dose, and timing of the MMA regimen, and to further elucidate the impact on spinal surgery outcomes.
