RT Journal Article
SR Electronic
T1 213 Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (PROSPECT) recommendations
JF Regional Anesthesia & Pain Medicine
JO Reg Anesth Pain Med
FD BMJ Publishing Group Ltd
SP A111
OP A112
DO 10.1136/rapm-2021-ESRA.213
VO 70
IS Suppl 1
A1 Peene, L
A1 Le Cacheux, P
A1 Sauter, AR
A1 Joshi, GP
A1 Beloeil, H
YR 2021
UL http://rapm.bmj.com/content/70/Suppl_1/A111.abstract
AB Background and Aims With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. [1, 4] 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 [5]. 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 (table 1). 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 (table 2).View this table:Abstract 213 Table 1 Overall recommendations for perioperative pain management in patients undergoing lumbar laminectomyView this table:Abstract 213 Table 2 Analgesic interventions that are not recommended for pain management in patients undergoing lumbar laminectomyConclusions 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.