Perioperative pain management: what is evidence based?

Adequate post-operative acute pain therapy after spinal surgical procedures is essential for many patients. However, patients already receiving chronic opioid therapy pre-operatively present a special challenge for the treating physician during the post-operative period when managing their acute pain. The team must consider multiple approaches of acute pain management and it is important to proceed according to current evidence-based methods. A wide spectrum of options for pain management after spinal surgery is currently available. This includes various therapeutic methods as well as regional anesthesia. Considering the various options, the method of choice for post-operative analgesia depends on the expected pain, therapy effectiveness, and the applicability with regard to potential side-effects. In addition to the basic analgesic therapy consisting of opioid and non-opioid drugs, chronic pain patients may require co-analgesics or combination analgesics from this class. Regional anesthesia is currently the predominant method of choice for post-operative acute pain management. Neuraxial blockage is especially important when considering all spinal procedures.