Background and Aims Patients presenting for spinal surgery often do so for the alleviation of pain symptoms. However, the surgery itself can be associated with significant pain. The recent PROSPECT guidelines on peri-operative pain management for laminectomy and complex spinal surgery mean that clinicians now have an evidence-based approach for the management of pain in these patient groups. The aim of our project was: to identify current prescribing practices amongst anaesthetists caring for spinal surgery patients; to gauge current awareness of PROSPECT guidelines and; to assess the use of NSAIDs in spinal surgery patients and understand the reasons that might deter their use.
Methods We conducted a closed-question survey of 33 anaesthetists in our neurosurgical department.
Results The three most commonly used intra-operative and postoperative analgesics included paracetamol, opioids and magnesium. 76% were not aware of the PROSPECT guidelines. Only 15% of respondents commonly used NSAIDs intra-operatively and only 39% commonly prescribed NSAIDs post-operatively. The risk of bleeding, surgical reluctance and the other risks associated with NSAIDs continue to be barriers to their use. 97% of respondents said that local guidelines endorsing the use of NSAIDs would encourage more confidence in using them.
Conclusions The results show that there is still reluctance to prescribe NSAIDs during spine surgery despite its proven benefits. With this in mind, we have incorporated the PROSPECT recommendations into a local guideline to encourage it use. We believe such a guideline will encourage evidence-based prescribing habits and so to, improve the peri-operative pain management of patients undergoing spinal surgery.
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