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. 2021 Oct;30(10):2925-2935.
doi: 10.1007/s00586-020-06661-8. Epub 2020 Nov 27.

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Laurens Peene #  1 , Pauline Le Cacheux #  2 , Axel R Sauter  3   4 , Girish P Joshi  5 , Helene Beloeil  6 ; PROSPECT Working Group Collaborators; European Society of Regional Anaesthesia
Affiliations

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Laurens Peene et al. Eur Spine J. 2021 Oct.

Abstract

Purpose: With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy.

Methods: A systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020-assessing post-operative pain using analgesic, anaesthetic and surgical interventions-were identified from MEDLINE, EMBASE and Cochrane Databases.

Results: Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)-2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions-gabapentinoids and intrathecal opioid administration-although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence.

Conclusion: Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.

Keywords: Analgesia; Evidence-based medicine; Laminectomy; Systematic review.

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