The Potential of Modern Non-Opioid Analgesics in the Prevention and Treatment of Pain Syndrome in Decompressive-Stabilizing Spine Surgeries.

BACKGROUND: Mts affecting the spine in 80% of cases are accompanied by chronic pain syndrome (CPS). Reducing opioid prescriptions in the postoperative (post-op) period is important not only to prevent side effects but also to reserve them for providing palliative care to these patients.

AIMS: To optimize post-op analgesia for cancer patients with CPS undergoing decompressive-stabilizing spine surgery.

MATERIALS AND METHODS: The study included 52 patients aged between 32 to 76 years (mean age 59±10 (95% CI 56-62) years), comprising 23 (44.2%) men and 29 (55.8%) women, with ASA I-III, CPS, and no strong opioid therapy for spinal Mts. Patients were randomized by type of post-op analgesia: in the control group, Group C (n=15, 28.8%) - tramadol was used, in Group D (n=18, 34.6%) - infusion of diclofenac and orphenadrine was conducted, and in Group I (n=19, 36.5%) - ibuprofen was administered. The intensity of post-op pain was measured using VAS (mm) at control points: extubation, transferring to the bed in PACU, 1 and 3 hours post-op, in the evening on the day of surgery, and in the morning on the 2nd post-op day. Evaluated were: the duration of the analgesic effect, its demand within the first post-op day, satisfaction with analgesia according to Likert scale 1 hour after analgesic administration, daily opioid requirement and duration until discharge, and the frequency of persistent post-op pain syndrome development.

RESULTS: Groups I and D showed a tendency for increased time to first analgesic request. An acceptable level of analgesia was achieved in all groups. Significant differences were observed in average pain intensity at rest measured by VAS (mm) in the morning on the 2nd post-op day between Groups D (Me=10) and C (Me=20). Satisfaction with analgesia according to Likert scale in all groups was rated as "excellent" or "good". The duration of opioid therapy was significantly lower in non-opioid groups (6 post-op days in Groups I, D versus 7 in the control group, p= 0.013).

CONCLUSIONS: Post-op analgesia methods using non-opioid analgesics are effective and possess opioid-sparing potential.