A decade ago, it seemed virtually impossible for patients to go home the same or next day after having spine surgery. Patient stay after any minor or major surgery was around 3 to 7 days, typically for treatment of post-surgical pain. The surgery itself was also very invasive with lots of muscle destruction, bigger incision and increased blood loss. Now with the advent of minimally invasive spine surgery, the procedure has become less invasive and less destructive.
Less invasive procedures are also greatly complemented by multimodal analgesia, which helps patients recover faster and have a more painless stay in the hospital.
Multimodal analgesia is defined as use of different modalities, or methods, in combination so as to have additive synergistic analgesic effects and less toxicity utilizing pharmacological and non-pharmacological analgesic techniques. The different methods act at different locations and by different mechanisms together to virtually block or neutralize all pain causing pathways. The use of multiple pain control methods gives a clinician more options to create a pain intervention plan customized to the patient’s comorbidities and side effects of the drugs.
Pain intervention starts right before surgery, continues throughout surgery to the post-surgery period and continues through recovery. Patients are given oral medications, such as Lyrica or Celebrex, a few hours before surgery. During surgery, patients are given Ketamine and the surgical site is infiltrated with a special combination of long-acting numbing medications, reducing surgical incision pain for at least 10 hours.
Toward the end of surgery, patients are administered suitable opioids. After surgery, the patients administer doses of the same opioid medication used during surgery as needed, allowing them to better control their pain. Opioids are complemented with intravenous Tylenol which has strong evidence of reducing pain. Other analgesics like Lidoderm patches, Toradol and Tramadol can also be used. Anti-inflammatories are usually avoided after fusion. Nonpharmacological treatment such as Transcutaneous Electrical Nerve Stimulation (TENS) and cold therapy have also been found to reduce pain further.
All of these pain management methods used together help reduce pain substantially and reduce the dosage of opioids required for analgesia. Ultimately, this helps patients recover faster and go home sooner.
Dr. Amit Bhandarkar M.B.B.S., M.S., M.D. is a fellowship trained, Orthopedic Spine surgeon. Dr. Bhandarkar evaluates and treats a wide variety of spine ailments consistent with his comprehensive spine training.
He has practiced and done fellowships in the USA, Canada, Seoul (South Korea), Maldives and India. His area of focus is minimally invasive spine surgery, and his special interests are spine related pain management and endoscopic spine surgery (the least invasive option) for lumbar disc related disorders.