Potential of modern nonopioid analgesics in the prevention and treatment of pain syndrome in decompressive stabilizing spine surgeries

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Abstract

BACKGROUND: Secondary (tumor) lesion of the spine in 80% of cases is accompanied by chronic pain syndrome (CPS). A decrease in opioid subsidies in the postoperative period is important not only to prevent side effects, but also in order to create a reserve when providing palliative care for patients with CP, due to the pathology of the skeletal muscle system.

AIM: To optimize postop analgesia for cancer patients with CPS undergoing decompressive-stabilizing spine surgery.

MATERIALS AND METHODS: We included 52 patients aged 32–76 (average age: 59±10 [95% CI: 56–62]) years, 23 (44.2%) men and 29 (55.8%) women, with physical status according to the classification of patients of the American Society of Anesthesiologists I–III, CPS without therapy were included strong opioids for spinal metastases. Patients were randomized according to the type of postop analgesia: tramadol was used in the control group (group K) (n=15, 28.8%), a combination of diclofenac and orphenadrine in group D (n=18, 34.6%), and ibuprofen in group I (n=19, 36.5%). Postoperative pain intensity deduced using the visual analog scale was determined during extubation, transfer to a bed in the intensive care unit, 1 and 3 hours postop, and 21:00 on the day of surgery and 06:00 on day 2. The effect duration of the analgesic under study, the need for anesthesia on the postop day, and satisfaction with Likert anesthesia 1 hour after administration were evaluated.

RESULTS: Significant differences in the average values of pain intensity at rest at 06:00 on postoperative day 2 between groups D (Me=10) and K (Me=20) were obtained. Satisfaction with pain relief according to Likert scale in the groups was rated “excellent” or “good.” The duration of opioid therapy was significantly lower in the nonopioid groups (six postop days in groups I and D versus seven in group K; p=0.013).

CONCLUSIONS: Postop analgesia methods using nonopioid analgesics are effective and possess opioid-sparing potential.

About the authors

Tatyana D. Lukonina

Herzen Moscow Research Institute of Oncology — Branch of the National Medical Research Center of Radiology

Author for correspondence.
Email: tatiyana.kretowa@yandex.ru
ORCID iD: 0009-0002-1203-2395
SPIN-code: 7937-3507
Russian Federation, Moscow

Victoria E. Khoronenko

Herzen Moscow Research Institute of Oncology — Branch of the National Medical Research Center of Radiology; Peoples’ Friendship University of Russia named after Patrice Lumumba

Email: khoronenko_mnioi@mail.ru
ORCID iD: 0000-0001-8845-9913
SPIN-code: 1971-6546

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Guzal R. Abuzarova

Herzen Moscow Research Institute of Oncology — Branch of the National Medical Research Center of Radiology; Russian Medical Academy of Continuous Professional Education

Email: abuzarova_mnioi@bk.ru
ORCID iD: 0000-0002-6146-2706
SPIN-code: 9876-4680

MD, Dr. Sci. (Med.), Professor

Russian Federation, Moscow; Moscow

Galina S. Alekseeva

National Medical Research Radiological Centre

Email: gs.alekseeva@nmirc.ru
ORCID iD: 0000-0001-8204-9032
SPIN-code: 9119-8286

MD, Dr. Sci. (Med.), Professor

Russian Federation, Obninsk

Artem V. Buharov

Herzen Moscow Research Institute of Oncology — Branch of the National Medical Research Center of Radiology

Email: artembuharov@mail.ru
ORCID iD: 0000-0002-2976-8895
SPIN-code: 8349-0930

MD, Dr. Sci. (Med.)

Russian Federation, Moscow

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2. Fig. 1. The level of initial pain intensity in the studied groups according to VAS at rest and during movement. Note. ВАШ — visual analog scale, K — control group, Д — group of combined NSAIDs (diclofenac+orphenadrine), И — ibuprofen group. The highlighted value is the median.

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3. Fig. 2. Dynamics of cortisol levels before and after surgery depending on the groups, mcg/dl. Note. K — control group, Д — group of combined NSAIDs (diclofenac+orphenadrine), И — ibuprofen group. The highlighted value is the median.

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4. Fig. 3. The proportion of patients with neuropathic pain before and after surgery. Note. p — coefficient of statistical significance of differences between groups, the differences in the indicators are statistically significant (p ≤0.05), K — control group, Д — group of combined NSAIDs (diclofenac+orphenadrine), И — ibuprofen group.

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5. Fig. 4. The proportion of patients with a continuing need for opioids and post-op pain syndrome in the study groups, %. Note. K — control group, Д — group of combined NSAIDs (diclofenac+orphenadrine), И — ibuprofen group.

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