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Perioperative Optimization of Pain Control in Patients Undergoing Spinal Surgery Using Multimodal Analgesia 

Perioperative Optimization of Pain Control in Patients Undergoing Spinal Surgery Using Multimodal Analgesia
Chapter:
Perioperative Optimization of Pain Control in Patients Undergoing Spinal Surgery Using Multimodal Analgesia
Author(s):

Newton Mei

and Ashwini D. Sharan

DOI:
10.1093/med/9780190913779.003.0012
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date: 03 April 2020

Inadequate pain control in patients with spinal pathology and after spine surgery not only places the patient at risk for a myriad of complications, but it also depletes healthcare resources. To be able to optimize pain relief in spine patients, the healthcare provider needs to understand the complexity of the underlying pain and be well versed in the medications that have been shown through research to provide significant analgesic relief. Multimodal analgesia (MMA) has gained popularity in recent years for its ability to synergistically treat pain using a variety of biochemical pathways, and its use has been applied across a variety of surgical procedures. In spine patients, evidence has identified gabapentinoids, NSAIDs, acetaminophen, ketamine, neuraxial anesthesia, and local anesthesia to be effective analgesic agents that should be considered for inclusion in MMA to manage pain in spine patients. As the literature continues to evolve, new agents such as dexamethasone and methadone may be added to the spine MMA repertoire. Furthermore, MMA should be customized to fit the patient, taking into account the patient’s age, medical comorbidities, allergies, and possible interactions with other prior medications. This general overview highlights the medications that should be incorporated in a spine patient’s MMA and recommends a basic algorithmic approach to developing a MMA to treat spine patients.

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