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Article Dans Une Revue European Spine Journal Année : 2021

Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations

Résumé

PURPOSE: With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid post-operative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one- or two-level lumbar laminectomy. METHODS: A systematic review utilizing the PROcedure-SPECific Post-operative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020-assessing post-operative pain using analgesic, anaesthetic and surgical interventions-were identified from MEDLINE, EMBASE and Cochrane Databases. RESULTS: Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a non-steroidal anti-inflammatory drug (NSAID) or cyclooxygenase (COX)-2 selective inhibitor administered preoperatively or intraoperatively and continued post-operatively, with post-operative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions-gabapentinoids and intrathecal opioid administration-although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence. CONCLUSION: Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID- or COX-2-specific inhibitor, continued into the post-operative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication post-operatively. Future studies are necessary to evaluate the efficacy of our recommendations.
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Dates et versions

hal-03038353 , version 1 (28-05-2021)

Identifiants

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Laurens Peene, Pauline Le Cacheux, Axel R Sauter, Girish P Joshi, Hélène Beloeil. Pain management after laminectomy: a systematic review and procedure-specific post-operative pain management (prospect) recommendations. European Spine Journal, 2021, 30 (10), pp.2925-2935. ⟨10.1007/s00586-020-06661-8⟩. ⟨hal-03038353⟩
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