Post-Operative Pain Management

Teri Holwerda, MSN, RN, ONC, APRN-BC Advanced Practice Nurse, Spine and Neuroscience Saint Mary's Health Care Neurosurgery Grand Rapids, MI, USA

Adequate post-operative pain management is essential in facilitating a patient's recovery from spinal surgery.

The adverse physiological effects of insufficient pain control can be manifested in many organ systems. The clinical effects include ventilation/perfusion abnormalities, atelectasis, pneumonia, hyperglycemia, protein catabolism, vasoconstriction, congestive heart failure, increased heart rate, arrhythmias, angina, myocardial infarction, decreased immune function, increased incidence of thromboembolism, ileus, and urinary retention. (102)

Patient-Controlled-Analgesia (PCA)
PCA has been shown to be more effective in pain management than as-needed intramuscular injections. Patients using PCA reported lower levels of post-operative pain and ambulated earlier than those receiving as-needed intramuscular injections. (103)

PCA and Intrathecal Analgesia
PCA and intrathecal analgesia have been used in spinal surgery patients with equal efficacy, but intrathecal analgesia can be more costly. (104,105)

Intrathecal administration of morphine prior to the close of the case can be an effective method to control post-operative pain in the first 24-hours after surgery. (106) Doses higher than 0.004-mg/kg were associated with lower respiratory rates and higher CO2 levels. (107)

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The care of the Adult Spine patient is complex and can be difficult to understand. All spine surgery is not the same and the complex procedures are often misunderstood by some healthcare providers, case managers, and insurance companies. Ms. Holwerda has organized this topic into logical sections for review with current information. Most importantly, the wide variety of management issues are also discussed.

Mary Rodts, DNP, CNP, ONC, FAAN