Page 32 - CASA Bulletin of Anesthesiologisy 2022 9(6)-1 (3)

CASA Bulletin of Anesthesiology

Adequate postoperative pain control following complex spine surgeries is a crucial
component of perioperative management for spine surgeries to accelerate postoperative recovery
and promote early mobilization. Multimodal analgesia is the ideal method for perioperative pain
management and starts with preoperative education and screening for risk factors. Patients who
are at high risk for postoperative pain or preoperative opioid use should be referred to the
perioperative pain clinic for further optimization of pain control prior to surgery. Prior to
surgery, patients should be started on gabapentinoids and consider intraoperative liposomal
bupivacaine infiltration at the surgical site. Postoperative pain regimen should include scheduled
acetaminophen, NSAIDs, COX-2 inhibitors, oral/IV/PCA opioids, lidocaine and/or ketamine
infusions. Although a specific pain regimen cannot be recommended from the literature, a
multimodal approach has consistently shown to provide health benefits with fewer opioid related
side effects and improved postoperative outcomes following complex spine surgeries.

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