5. Use a multimodal
post-op pain management plan
Following most spinal surgeries, patients will experience some level
of discomfort. While traditionally this was treated with opioids, new
multimodal plans help to avoid the negative side affects associated
with opioids and manage patients' pain more efficiently.
Compared to other surgeries, patients undergoing spinal proce-
dures are more likely to already be using long-term opioids to treat
chronic pain. A multi-pronged approach using some combination of
local anesthetic, NSAIDs, gabapentinoids and/or acetaminophen
can help control pain, especially for patients with a high opioid tol-
erance. Additionally, some surgeons have success using pain pumps
or a liposome injection of bupivacaine in more complex outpatient
spine cases. Surgeons should work with anesthesia providers to
develop a consistent pain management protocol.
But sometimes with spinal surgery, patients feel more than just the
typical discomfort. Post-op radiculopathy — where the patient has
radiating pain that stays the same as it was before surgery or even
increases dramatically — is a rare complication that does occur.
Inflammation often causes post-op radiculopathy, but it can also be
the result of misplaced instrumentation. Surgeons can decrease their
odds of making these errors by using low-dose C-arms for intraopera-
tive imaging, or newer spinal navigation systems to ensure their accu-
racy during the procedure. Notify patients of the risk of post-op
radiculopathy, and tell them in their discharge instructions to call
their surgeon immediately if they're experiencing the same or increas-
ing levels of pain or weakness in their back or legs after surgery. OSM
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O C T O B E R 2 0 1 5 | O U T P A T I E N TS U R G E R Y. N E T
Dr. Khanna (khannanit@hotmail.com) is a spine care specialist trained in minimally invasive surgical
techniques at Orthopaedic Specialists of Northwest Indiana in Munster, Ind.