Postoperative pain management after spinal fusion surgery: an analysis of the efficacy of continuous infusion of local anesthetics

Abstract

Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery.

Keywords: continuous infusion of local anesthetics; idiopathic scoliosis; post-operative pain management; spinal fusion.

Fig. 1

Opioid use for first 24 hours after surgery. Graph illustrating the mean patient-controlled analgesia (PCA) and total opioid use during the first postoperative day for patients treated according to protocol (light gray) and patients additionally treated with continuous infusion of local anesthetics (CILA; dark gray). Bars indicate standard deviations. *Statistically significant difference (p ≤ 0.05).

Fig. 2

Pain scores for the immediate postoperative period and the first 24 hours after surgery. Graph showing mean pain scores taken both immediately after the surgery, and the mean pain scores for the first 24 hours after surgery for the protocol (light gray) and continuous infusion of local anesthetics (CILA; dark gray) groups. Bars indicate standard deviations.

Fig. 3

Pain scores for the first 24 hours after surgery. Graph illustrating median pain scores for each hour, hours 1 to 24, after surgery, for the protocol (light gray diamonds) and continuous infusion of local anesthetics (CILA; black open circles) groups.