Acute Pain Management Protocol for Spine Procedures

The total number of spine surgeries performed has seen an upward trend over the past several decades not only in the United States but worldwide. Spine surgery is associated with moderate to severe postoperative pain and inadequate analgesia in patients undergoing spine surgery results in poor outcomes, delayed mobilization and rehabilitation, higher rates of admission and poor satisfaction. Although majority of lumbar spine procedures are still performed under general anesthesia, there is a large body of evidence that supports the use of regional interventions. Opportunities for regional anesthesia and analgesia have expanded recently due to emphasis on the opioid-minimizing approach for spine care (Table 1). Both neuraxial and truncal analgesia techniques have been tried, including epidural analgesic, spinal anesthesia, erector spinae plane blocks and thoracolumbar inter-fascial plane blocks. All these techniques work to control pain by different mechanisms and offer enhanced analgesia for a longer duration with lower dosage and side effects compared with administration of systemic opioids. In this chapter we will discuss regional analgesic approaches to manage pain after spine surgery.