Volume 8, Issue 3 (9-2026)
Tabari Biomed Stu Res J 2026, 8(3): 12-23 |
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Sobhani S, Hojjati M. Opioid-Sparing Pharmacological Strategies for Pain Management After Lumbar Spine Surgery: A Narrative Review. Tabari Biomed Stu Res J 2026; 8 (3) :12-23
URL: http://tbsrj.mazums.ac.ir/article-1-3919-en.html
URL: http://tbsrj.mazums.ac.ir/article-1-3919-en.html
1- Department of Anesthesiology, Faculty of Medicine, University of Mazandaran, Sari, Iran.
2- Department of Burn Surgery, Faculty of Medicine, University of Mazandaran, Sari, Iran.
2- Department of Burn Surgery, Faculty of Medicine, University of Mazandaran, Sari, Iran.
Abstract:
Postoperative pain after lumbar spine surgery is generated by skin and muscle injury, periosteal and osseous nociception, neural manipulation, and pre-existing neuropathic sensitization. Opioids remain effective rescue analgesics, but dose-related nausea, ileus, sedation, respiratory depression, delirium, and the risk of persistent postoperative use have accelerated adoption of multimodal, opioid-sparing pathways. This narrative review synthesizes contemporary evidence for pharmacological strategies after lumbar discectomy, decompression/laminectomy, and lumbar fusion, emphasizing procedure intensity, patient risk, and the strength of spine-specific data. PubMed/MEDLINE and reference lists of major systematic reviews, meta-analyses, randomized trials, and consensus guidance were searched through September 14, 2026. The most consistent foundation is scheduled acetaminophen plus a nonsteroidal anti-inflammatory drug (NSAID) or cyclooxygenase-2 inhibitor when not contraindicated, with local anesthetic techniques and rescue opioids. Intravenous acetaminophen can reduce early opioid use versus placebo after lumbar disc surgery, but a recent ambulatory-spine randomized trial did not establish a clinically important advantage over oral acetaminophen. Short-course NSAIDs reduce pain and opioid consumption; newer fusion data suggest that risk to arthrodesis is exposure-dependent rather than a class-wide absolute contraindication, with prolonged or high-dose ketorolac warranting particular caution. Ketamine has the clearest role in painful fusion procedures and opioid-tolerant patients. Gabapentinoids show opioid-sparing signals in spine-specific trials but should not be routine because clinically modest benefits must be balanced against dizziness, sedation, and respiratory risk when combined with opioids. Evidence for dexmedetomidine and intravenous lidocaine is inconsistent; magnesium is promising but less standardized
Keywords: Lumbar spine surgery, multimodal analgesia, opioid-sparing, postoperative pain, acetaminophen, NSAIDs, ketamine, gabapentinoids
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