Pre-emptive and multi-modal perioperative pain management may improve quality of life in patients undergoing spinal surgery

Background: Compared to an abundance of data on surgical techniques for degenerative spine conditions and the outcomes thereof, little is available to guide optimal perioperative pain management after spinal surgery. The aim of this study was to survey patterns of perioperative pain management after spinal surgery and to investigate the effects of perioperative pain management, such as pre-emptive analgesia and multi-modal postoperative pain management, on acute postoperative satisfaction, pain reduction, and health-related quality of life in patients undergoing spinal surgery. Study design: Non-blind multicenter prospective observational clinical series. Setting: Seventeen tertiary hospitals (14 hospitals attached to medical colleges and 3 general hospitals). Methods: Pain management protocols of 393 patients (153 men, 240 women; mean age of 67 years, ranging from 21 to 91 years) from 17 tertiary hospitals after spinal surgery for degenerative spine disease were evaluated using a self-administered questionnaire. Results: A total of 79 (20%) patients received pre-emptive analgesics, which included cyclooxygenase-2 (COX-2) inhibitors, with or without administration of anticonvulsants, immediately before surgery at the time of antibiotic prophylaxis. Postoperative pain was managed mainly by multi-modal therapy (363 cases, 92%), along with various combinations of patient controlled anesthesia (PCA), conventional nonsteroidal anti-inflammatory drugs (NSAIDs), COX- 2 inhibitors, and narcotics. Self-reported levels of pain were not significantly different among postoperative multiple modalities of pain management, but were different significantly for preemptive pain management regimens (P < 0.05, independent t-test). The number of patients that reported the self-administrative use of PCA was higher in the no pre-emptive pain management group compared to the pre-emptive group (P < 0.05). In regards to EQ-5D usual activity, depression/ anxiety and self-care improved significantly in the pre-emptive pain management group when measured at 2 weeks postoperative (P < 0.05). Limitations: The limitation of our study is that it is not a randomized controlled observational study. Conclusions: Pre-emptive analgesia and multi-modal pain management after spinal surgery may lead to better health-related quality of life, greater patient satisfaction, and less postoperative pain.