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Year : 2016  |  Volume : 3  |  Issue : 3  |  Page : 83-89

Major surgeries are more painful: Perioperative pain management and the role of preexisting chronic pain in two types of spine surgery

1 Resident, Department of Anesthesia, Luzerner Kantonsspital, Lucerne, Switzerland
2 Senior Physician, Department of Anesthesia, Luzerner Kantonsspital, Lucerne, Switzerland
3 Professor, Department of Anesthesia, Luzerner Kantonsspital, Lucerne, Switzerland
4 Private Lecturer, Division of Neurosurgery, Luzerner Kantonsspital, Lucerne Switzerland and Division of Neurosurgery, University of Basel Basel, Switzerland

Correspondence Address:
Christoph J Konrad
Professor, Department of Anesthesia, Luzerner Kantonsspital, Lucerne
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Source of Support: None, Conflict of Interest: None

DOI: 10.5005/jp-journals-10039-1097xs

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Aim: To answer the question whether the postoperative pain intensity and individual satisfaction correlate with the extent of surgery in two distinct types of spinal surgery and whether the perioperative pain management differs between the two groups in the context of chronic preoperative pain. Materials and methods: The PAIN OUT assessment tool was used for this retrospective comparative study. One hundred and eighty five nonconsecutive patients were grouped into two surgical groups: Group A (= “minor” operations) were patients undergoing either kyphoplasty, microsurgical fenestration for disk hernia removal, or decompression of spinal stenosis. Group B (= “major” operations) were patients who underwent spinal instrumentation of at least one lumbar segmental level in addition to microsurgical decompression. Results: In group A (n = 146) the amount of fentanyl administered intraoperatively per hour was higher. Patients in group B (n = 39) underwent longer operation times and received more often remifentanil. They also indicated higher postoperative pain scores and longer pain duration, desired more often additional pain medication, and were less satisfied with analgesic treatment. There was no significant difference in preoperative chronic pain between groups A and B. Conclusion: More invasive spinal surgeries cause significantly more pain and less patient satisfaction, which we think is largely due to an insufficient perioperative pain management. Contrary to prior reports, the presence of chronic preoperative pain did not predict higher pain perception in the two groups. Clinical significance: Chronic low back pain is a high prevalent problem with significant clinical and socioeconomic consequences. Current pain management concepts – especially in a perioperative setting – are still unsatisfactory.

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