Perioperative pain management for spine surgeries

Abstract

Elective spine surgeries are performed when conservative measures fail to adequately address back pain due to osteoarthritis or congenital deformities affecting quality of life adversely. With a growing aging population, the volume of thoracolumbar spine surgeries, such as anterior fusions, are expected to increase from 46,903 to 55,528, and posterior fusion surgeries are expected to increase from 248,416 to 297,994 from 2020 to 2040, indicating an eminent substantial burden on the health care systems. 1 Unfortunately, up to 57% of patients undergoing elective major spine surgeries experience poor pain control after surgery. 2 Perioperative pain management can be challenging not just due to the nature of the surgery but also due to some unique features in patients presenting for these surgeries, like preexisting chronic pain, adolescence, or advanced age. Poorly controlled pain is associated with increased opioid consumption, delayed rehabilitation, increased hospital length of stay (LOS), and increased rates of complications. 3 Inadequate analgesia is also associated with the development of chronic pain and a signi fi cant systemic in fl ammatory response, leading to a reduction in overall quality of life. 4 The fi eld of spine surgery has made enormous strides over the past 100 years, which has led to improved surgical outcomes and reduced patient morbidity. With safer and more ef fi cient techniques, some spinal surgeries are now possible as ambulatory procedures. 5 This has led to growing interest in the role of regional anesthesia as an alternative as well as a supplement to traditional general anesthesia (GA) for spine surgeries. In