Prevention and treatment of postoperative pain after lumbar spine procedures: a systematic review.

BACKGROUND AND OBJECTIVE:

In the last decades, in developed countries, spine procedures (surgical and percutaneous) had the highest absolute increase in case volume trend. Optimal approach to prevent and treat postoperative pain is continuously evolving. This systematic literature review presents evidence on safety and efficacy of pharmacological and non-pharmacological therapies to prevent and treat postoperative pain after lumbar spine procedures.

DATABASES AND DATA TREATMENT:

Publications listed in PUBMED and EMBASE were considered to identify randomized clinical trials suitable for inclusion in this systematic review. Key words for literature search were selected, with authors' agreement, using the PICOS approach.

RESULTS:

Fifty-nine randomized clinical trials (involving a total of 4238 patients, with age range 18-86 years) published between January 2012 and September 2017 were retrieved. Data are presented according to the timing of therapy administration.

CONCLUSION AND RECOMMENDATIONS:

Clinical evidence on perioperative pain management in patients undergoing spine procedures have significantly evolved after the review published in 2012. Aim of this systematic review is to report the latest evidence published. These include: the preoperative use of dexamethasone, that showed to be able to reduce pain at mobilization but not pain at rest and total morphine consumption; the use of gabapentinoids as part of a multimodal analgesic approach; safety and effectiveness of intraoperative use of ketamine, dexketoprofen, and tramadol. Finally, electrical nerve stimulation is gaining interest and is potentially suitable for the clinical needs. This article is protected by copyright. All rights reserved.