Anesthesiology, V 126 • No 5 822 May 2017 S EVERE pain in the early postoperative period remains a common yet underestimated and undertreated problem. Despite advances in pain management strategies, many surgical patients continue to suffer from moderate-to-severe pain, particularly during the first three postoperative days (PODs).1,2 Acute pain after spinal fusion surgery may be particularly difficult for the clinician to manage. Patients undergoing complex spine surgery often present with chronic neuropathic pain and dependence on oral opioid medication. Opioid-induced hyperalgesia and acute opioid tolerance may contribute to postoperative pain that is refractory to treatment with conventional doses of pain medications. Furthermore, chronic neuropathic pain may sensitize patients to painful stimuli after surgery.3 Appropriate control of pain is essential for enhancing recovery. Inadequate postoperative analgesia is associated with the development of a variety of adverse events, including cardiac and pulmonary complications, chronic postsurgical pain, decreased patient satisfaction, and increased morbidity and mortality.4,5 In an analysis of pain intensity following 179 surgical procedures, median pain scores were second highest in patients undergoing posterior spinal fusion.1 Clinically effective techniques for managing pain after spinal fusion surgery are therefore essential for improving patient outcomes. Several analgesic management strategies have been evaluated in this patient population, including the use of patient-controlled analgesia (PCA) What We Already Know about This Topic
