Opioid use with back surgery
As with any patient having surgery, a patient having spinal surgery is expected to experience pain post-operatively. In fact, very often the patient having back surgery has been experiencing pain for an extended period of time prior to having the surgery. That pain may have been treated with opioids. Some experts say opioid tolerance begins building the moment the narcotic enters the body. That tolerance could lead to addiction with continued use. With those side effects and risks in mind, surgeons and anesthesiologists are looking for alternative pain management methods.
Erector spinae plane blocks
An ESP block is comprised of ultrasound-guided injections placed along either side of the spine. The injection of non-opioid medications can reduce or even eliminate use of opioid analgesics for spinal surgery. Nerve blocks such as these block the brain from feeling pain and have shown great success in aiding with post-operative pain as well. Some medications used for a nerve block can also be administered via a pain pump. This device delivers the medicine through a catheter placed at the appropriate nerve site during surgery. Patients may then use the pump for several days after surgery to help control pain.
Enhanced Recovery After Surgery (ERAS)
The ERAS protocol has seen great success. Patients receive education not only regarding the procedure but also meet with specialists regarding pain management, nutrition, sleep aids, smoking cessation, and other topics that could affect recovery. Patients are expected to be up and moving 3-5 times per day beginning the first day after surgery. That movement assists the body in recovery by increasing blood flow and deep breathing, strengthening muscles, and helping the body wake up from the anesthesia. Everything in the protocol is aimed at managing pain and speeding the healing process but with minimal use of opioids. Mild pain is sometimes addressed with non-opioid, non-narcotic medications.
Minimally invasive surgery
As opposed to traditional surgeries, minimally invasive surgeries use small incisions and the use of an flexible endoscope or robot to operate. With minimally invasive spine surgery (MISS), patients typically recover faster and experience less pain. This decrease in pain leads to lower opioid use and better pain management. When possible, patients should discuss with the surgeon the benefits of minimally invasive surgery.
Avoiding opioids is possible
Alternative anesthetic agents and methods such as nerve blocks can aid in managing pain both during and after surgery. Patients that truly want to avoid opioid use have a variety of alternative pain control methods ranging from acupuncture to physical therapy and cognitive-behavioral therapy. Additionally, minimally invasive surgery may be a way to decrease surgical pain altogether, which lowers a patient’s need for pain medication. Patients undergoing surgery should consult with the surgeon on pain management options to make opioid-free back surgery a reality.