Anesthesia techniques in complex spine surgery

Postoperative analgesic options after spine surgery: finding the optimal treatment strategies

INTRODUCTION

Spine surgery is one of the most common types of surgeries performed in the United States; however, managing postoperative pain following spine surgery has proven to be challenging. Patients with spine pathologies have higher incidences of chronic pain and resultant opioid use and potential for tolerance. Implementing a multimodal plan for postoperative analgesia after spine surgery can lead to enhanced recovery and outcomes.

AREAS COVERED

This review presents several options for analgesia following spine surgery with an emphasis on multimodal techniques to best aid this specific patient population. In addition to traditional therapeutics, such as acetaminophen, non-steroidal anti-inflammatory medications, and opioids, we discuss intrathecal morphine administration and emerging regional anesthesia techniques.

EXPERT OPINION

Several adjuncts to improve analgesia following spine surgery are efficacious in the postoperative period. Intrathecal morphine provides sustained analgesia and can be instilled intraoperatively by the surgical team under direct visualization. Local anesthetics deposited under ultrasound guidance by an anesthesiologist trained in regional techniques also provide the opportunity for single injections or continuous analgesia via an indwelling catheter.

A rare anesthetic complication involving central line access during lumbar spine surgery: a case report and review

STUDY DESIGN

A case report describing a rare perioperative complication involving the intrathoracic placement of a central venous catheter during spine surgery leading to hemodynamic instability.

OBJECTIVE

To review the efficacy of central line use in perioperative spine patients and to describe the diagnosis, emergent treatment, and postoperative care of a unique case of intrathoracic extravasation of propofol.

SUMMARY OF BACKGROUND DATA

Although placement of central line access is a safe procedure, complications can occur. A case in which a venous catheter delivering propofol into the thorax has never been documented.

METHODS

A 48-year-old woman presented for revision spine surgery, and a central line was placed. After placement of spinal instrumentation, she became hemodynamically unstable secondary to mediastinal compression caused by pressure from intraoperative propofol and fluid insufflation.

RESULTS

A chest tube was placed, and with aggressive pulmonary toilet and physical therapy, she did well and was discharged without noted symptoms.

CONCLUSION

The efficacy of central line use should be carefully considered in perioperative spine surgery, and in patients with significant risk factors, placement of central venous access should be radiographically confirmed.