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Perioperative Opioid Analgesics of Use in Pain Management for Spine Surgery 

Perioperative Opioid Analgesics of Use in Pain Management for Spine Surgery
Chapter:
Perioperative Opioid Analgesics of Use in Pain Management for Spine Surgery
Author(s):

Kenneth Fomberstein

, Marissa Rubin

, Dipan Patel

, John-Paul Sara

, and Abhishek Gupta

DOI:
10.1093/med/9780190626761.003.0004
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date: 20 April 2021

This chapter compares the basic properties of several opioid analgesics and explores their applications in perioperative pain control in spine surgery. Parenteral opioids have long been the cornerstone of treatment for postoperative pain; they work by inhibiting voltage-gated calcium channels and increasing potassium influx, which results in reduced neuronal excitability, thereby inhibiting the ascending transmission of painful stimuli and activating the descending inhibitory pathways. This chapter reviews concepts including opioid conversion and rotation, opioid tolerance, and opioid cross-tolerance. It discusses common opioid side effects, and it explores the perioperative use of several specific opioids including remifentanil, sufentanil, methadone, oxycodone, morphine, and tapentadol and discusses their use in spine surgery. Additionally, this chapter discusses patient-controlled analgesia (PCA) and its importance in postoperative pain control.

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