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Pain Management After Spine Surgery
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Posted on: 01/31/2008
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Pain after back surgery can slow a patient down. Recovery and rate of return to daily activities, including work can be affected. Morphine is a common drug used to control the pain. But as an opioid, morphine has some drawbacks.
In this study, antiinflammatory drugs are combined with morphine to see if less morphine can be used. A special type of antiinflammatory called cyclooxygenase-2 (COX-2) inhibitors are used. Coxibs have fewer problems with bleeding and blood loss compared to other types of antiinflammatories.
Three groups of patients were included based on the type of surgery done. The first group had a discectomy (disc removed). The second group had a decompression laminectomy. A small portion of the bone over the herniated disc was removed to take pressure off the spinal nerve root. The third group had a spinal fusion (after discectomy).
Surgery was done from a posterior (back of the spine) approach in all cases. Patients were allowed to use patient-controlled analgesia (PCA). This means they had a pump that could release morphine into their system as needed.
Patients in all three groups either received the morphine/coxib combination or a placebo (liquid with no drug). The drug or placebo was given 30 minutes before the operation. It was given again every 12 hours after surgery for 48 hours. The PCA pump was removed at the end of the second day.
Results were measured based on pain levels (at rest and during movement), total morphine used, and the patient's subjective ratings. Patients receiving both drugs at the same time had significantly better results.
Ninety per cent (90%) of them had at least 50 per cent improvement after 48 hours. This compared to 58 per cent of the patients in the PCA morphine-alone group who had 50 per cent improvement. The benefit of the combined drug was seen in all three groups.
The authors also noticed that pain wasn't the only effect patients were interested in. They were willing to trade-off pain relief for fewer side effects from the drugs.
At the same time, it was observed that the combined drug provided pain relief at rest and during movement. Morphine used alone gave only reduced pain at rest. It made no difference in pain levels during movement.
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References:
Kitti Jirarattanaphochai, MD, et al. Effect of Parecoxib on Postoperative Pain After Lumbar Spine Surgery. In Spine. January 15, 2008. Vol. 33. No. 2. Pp. 132-139.
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