Complex perioperative pain management in the treatment of patients with degenerative lumbar spine diseases

Close metadata

OBJECTIVE

To analyze the effect of complex perioperative pain management on postoperative pain syndrome and cognitive functions in patients with degenerative lumbar spine diseases.

MATERIAL AND METHODS

A prospective study included 85 patients with degenerative lumbar spine diseases. Two groups were distinguished. In the control group (n=42), conventional surgical technologies and anesthesia were used. In the main group (n=43), we additionally applied multimodal perioperative analgesia. Comparative analysis included VAS score of pain syndrome and need for pain relief, Montreal Cognitive Assessment Score (MoCA) and Frontal Assessment Battery (FAB) score.

RESULTS

Less VAS score and in-hospital need for analgesia were observed in the main group compared to the control group (p<0.001). Twenty-seven patients (62.8%) in the main group did not require painkillers since the 6^th postoperative day. According to MoCA and FAB scores, postoperative cognitive functions were significantly better in the main group (p<0.05). Mild-to-moderate cognitive impairment was detected in 29 (69%) and 7 (16.3%) patients in the main and control group, respectively (p=0.007). There was a greater number of adverse effects following anesthesia in the control group (28.6% and 9.3%, respectively, p=0.004).

CONCLUSION

Complex perioperative anesthesia with preoperative administration of ketoprofen, intraoperative injection of dexmedetomidine and postoperative administration of paracetamol and wound edge infiltration with ropivacaine is effective and safe approach. These measures significantly reduce severity of local pain syndrome, incidence of cognitive disorders and risk of adverse anesthesia-induced effects.

Keywords:

lumbar spine

degenerative diseases

spinal surgery

postoperative pain syndrome

multimodal perioperative analgesia

cognitive functions

prevention of cognitive dysfunction

Authors:

Byvaltsev V.A.

Irkutsk State Medical University;
Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»;
Irkutsk State Medical Academy of Postgraduate Education

Goloborodko V.Yu.

Irkutsk State Medical University;
Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»

Kalinin A.A.

Irkutsk State Medical University;
Private Healthcare Institution «Clinical Hospital «Russian Railways-Medicine»

Pestryakov Yu.Ya.

Irkutsk State Medical University

Shepelev V.V.

Irkutsk State Medical University

Received:

24.10.2020

Accepted:

27.10.2020

List of references:

Grotle M, Småstuen MC, Fjeld O, Grøvle L, Helgeland J, Storheim K, Solberg TK, Zwart JA. Lumbar spine surgery across 15 years: trends, complications and reoperations in a longitudinal observational study from Norway. BMJ Open. 2019;9(8):e028743. https://doi.org/10.1136/bmjopen-2018-028743
Koenders N, Rushton A, Verra ML, Willems PC, Hoogeboom TJ, Staal JB. Pain and disability after first-time spinal fusion for lumbar degenerative disorders: a systematic review and meta-analysis. Eur Spine J. 2019;28(4):696-709. https://doi.org/10.1007/s00586-018-5680-3
Byvaltsev VA, Kalinin AA, Belykh EG, Goloborodko VYu, Borisov VE. Analysis of the efficacy of local use of bupivacaine with epinephrine when performing multilevel decompression and stabilization interventions in the lumbosacral spine. Anesteziologiya i reanimatologiya. 2018;63(1):21-26. (In Russ.).
Terracina S, Robba C, Prete A, Sergi PG, Bilotta F. Prevention and Treatment of Postoperative Pain after Lumbar Spine Procedures: A Systematic Review. Pain Pract. 2018;18(7):925-945. https://doi.org/10.1111/papr.12684
Jain P, Raza K, Singh S, Kumari C, Kaler S, Rani N. Lumbar sympathetic chain: anatomical variation and clinical perspectives. Clin Ter. 2016;167(6):185-187. https://doi.org/10.7417/CT.2016.1970
Polupan AA, Birg TM, Oshorov AV, Savin IA. Correction of arterial hypertension in the postoperative period in neurosurgical patients. Anesteziologiya i reanimatologiya. 2017;62(3):190-194. (In Russ.).
Staartjes VE, de Wispelaere MP, Schröder ML. Improving recovery after elective degenerative spine surgery: 5-year experience with an enhanced recovery after surgery (ERAS) protocol. Neurosurg Focus. 2019;46(4):E7. https://doi.org/10.3171/2019.1.FOCUS18646
Argoff CE. Recent management advances in acute postoperative pain. Pain Pract. 2014;14(5):477-487. https://doi.org/10.1111/papr.12108
Meissner W, Huygen F, Neugebauer EAM, Osterbrink J, Benhamou D, Betteridge N, Coluzzi F, De Andres J, Fawcett W, Fletcher D, Kalso E, Kehlet H, Morlion B, Montes Pérez A, Pergolizzi J, Schäfer M. Management of acute pain in the postoperative setting: the importance of quality indicators. Curr Med Res Opin. 2018;34(1):187-196. https://doi.org/10.1080/03007995.2017.1391081
Savitha KS, Dhanpal R, Kothari AN. The Effect of Multimodal Analgesia on Intraoperative Morphine Requirement in Lumbar Spine Surgeries. Anesth Essays Res. 2017;11(2):397-400. https://doi.org/10.4103/0259-1162.194553
Koo HM, Yong MS, Na SS. The effect of low-intensity laser therapy (LILT) on cutaneous wound healing and pain relief in rats. J Phys Ther Sci. 2015;27(11):3421-3423. https://doi.org/10.1589/jpts.27.3421
Solenkova AV, Lubnin AYu, Konovalov NA, Korolishin VA, Asyutin DS, Martynova MA, Moshkin AV, Arefieva IA, Teryaeva NB. Postoperative prolonged epidural analgesia in spinal neurosurgical interventions. Part II. Effect of prolonged epidural analgesia on the overall inflammatory stress response. Anesteziologiya i reanimatologiya. 2017;62(3):178-184. (In Russ.).
Ezhevskaya AA, Ovechkin AM, Prusakova ZB, Zagrekov VI, Mlyavykh SG, Anderson DG. Relationship among anesthesia technique, surgical stress, and cognitive dysfunction following spinal surgery: a randomized trial. J Neurosurg Spine. 2019;6:1-8. https://doi.org/10.3171/2019.4.SPINE184
Oderda GM, Gan TJ, Johnson BH, Robinson SB. Effect of opioid-related adverse events on outcomes in selected surgical patients. J Pain Palliat Care Pharmacother. 2013;27(1):62-70. https://doi.org/10.3109/15360288.2012.751956
Müller J, Nowak S, Vogelgesang A, von Sarnowski B, Rathmann E, Schmidt S, Rehberg S, Usichenko T, Kertscho H, Hahnenkamp K, Flöel A, Schroeder HW, Müller JU, Fleischmann R. Evaluating Mechanisms of Postoperative Delirium and Cognitive Dysfunction Following Elective Spine Surgery in Elderly Patients (CONFESS): Protocol for a Prospective Observational Trial. JMIR Res Protoc. 2020;9(2):e15488. https://doi.org/10.2196/15488.
Belykh E, Carotenuto A, Kalinin AA, Akshulakov SK, Kerimbayev T, Borisov VE, Aliyev MA, Nakaji P, Preul MC, Byvaltsev VA. Surgical Protocol for Infections, Nonhealing Wound Prophylaxis, and Analgesia: Development and Implementation for Posterior Spinal Fusions. World Neurosurg. 2019;123:390-401.e2. https://doi.org/10.1016/j.wneu.2018.11.135
Ghasem A, Sharma A, Greif DN, Alam M, Maaieh MA. The Arrival of Robotics in Spine Surgery: A Review of the Literature. Spine (Phila Pa 1976). 2018;43(23):1670-1677. https://doi.org/10.1097/BRS.0000000000002695
Virk SS, Yu E. The Top 50 Articles on Minimally Invasive Spine Surgery. Spine. 2017;42(7):513-519. https://doi.org/10.1097/BRS.0000000000001797
Fabling JM, Gan TJ, Guy J, Borel CO, el-Moalem HE, Warner DS. Postoperative nausea and vomiting. A retrospective analysis in patients undergoing elective craniotomy. J Neurosurg Anesthesiol. 1997;9(4):308-312.
Soh S, Shim JK, Song JW, Kim KN, Noh HY, Kwak YL. Postoperative Delirium in Elderly Patients Undergoing Major Spinal Surgery: Role of Cerebral Oximetry. J Neurosurg Anesthesiol. 2017;29(4):426-432. https://doi.org/10.1097/ANA.0000000000000363
Licina A, Silvers A, Laughlin H, Russell J, Wan C. Proposed pathway for patients undergoing enhanced recovery after spinal surgery: protocol for a systematic review. Syst Rev. 2020;9(1):39. https://doi.org/10.1186/s13643-020-1283-2
Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017;152(3):292-298. https://doi.org/10.1001/jamasurg.2016.4952
Smith J, Probst S, Calandra C, Davis R, Sugimoto K, Nie L, Gan TJ, Bennett-Guerrero E. Enhanced recovery after surgery (ERAS) program for lumbar spine fusion. Perioper Med (Lond). 2019;8:4. https://doi.org/10.1186/s13741-019-0114-2
Arefiev AM, Kulikov AS, Lubnin AYu. Dexmedetomidine in neuroanesthesiology. Anesteziologiya i reanimatologiya. 2017;62(3):213-219. (In Russ.).
Naik BI, Nemergut EC, Kazemi A, Fernández L, Cederholm SK, McMurry TL, Durieux ME. The Effect of Dexmedetomidine on Postoperative Opioid Consumption and Pain After Major Spine Surgery. Anesth Analg. 2016;122(5):1646-1653. https://doi.org/10.1213/ANE.0000000000001226
Dahl JB, Møiniche S. Relief of postoperative pain by local anaesthetic infiltration: efficacy for major abdominal and orthopedic surgery. Pain. 2009;143(1-2):7-11. https://doi.org/10.1016/j.pain.2009.02.020
Alboog A, Bae S, Chui J. Anesthetic management of complex spine surgery in adult patients: a review based on outcome evidence. Curr Opin Anaesthesiol. 2019;32(5):600-608. https://doi.org/10.1097/ACO.0000000000000765
Evered LA, Silbert BS. Postoperative Cognitive Dysfunction and Noncardiac Surgery. Anesth Analg. 2018;127(2):496-505. https://doi.org/10.1213/ANE.0000000000003514
Solenkova AV, Bondarenko AA, Dzyubanova NA, Lubnin AYu. Assessment of the state of cognitive functions during operations on the spine and spinal cord. Anesteziologiya i reanimatologiya. 2012;4:38-42. (In Russ.).
Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol. 2015;15:154. https://doi.org/10.1186/s12871-015-0130-9
Chen K, Wei P, Zheng Q, Zhou J, Li J. Neuroprotective effects of intravenous lidocaine on early postoperative cognitive dysfunction in elderly patients following spine surgery. Med Sci Monit. 2015;21:1402-1407. https://doi.org/10.12659/MSM.894384

Close metadata