Preoperative and postoperative anesthetic and analgesic techniques for minimally invasive surgery of the spine.

摘要

STUDY DESIGN: A review of methods to optimize anesthesia and analgesia for minimally invasive spine procedures. OBJECTIVE: To provide information to surgeons and anesthesiologists of methods to provide optimal anesthesia and pain control for minimally invasive spine surgery with an emphasis on preoperative planning. SUMMARY OF BACKGROUND DATA: Postoperative pain management in patients undergoing minimally invasive spine surgery is a challenge for the perioperative anesthesiologist. In addition to the incisional pain, trauma to deeper tissues, such as ligaments, muscles, intervertebral discs, and periosteum are reasons for significant pain. The increasing number of minimally invasive surgeries and the need for improved and rapid return of the patient of functionality have brought the perioperative anesthesiologist and the surgeon closer. METHODS: We undertook a review of the literature currently available on anesthesia and analgesia for minimally invasive spine surgery with an emphasis on preoperative planning. A large number of reports of randomized controlled clinical trials with respect to perioperative anesthetic and postoperative pain management for minimally invasive spine surgery are reviewed and the applicability of some of the principles and protocols used for other types of minimally invasive surgical procedures are placed in the context of spine surgery. RESULTS: It is important to understand and implement a multimodal analgesic therapy during a patient's preoperative visits. Perioperative multimodal analgesia with a fast-track anesthetic protocol is also important and provided in the manuscript. This protocol poses a challenge to the anesthesiologist with respect to neurophysiologic monitoring, which requires further study. The postoperative analgesic management should be a continuance of the multimodal analgesia provided before surgery. Some drugs are not appropriate for patients undergoing fusion surgery because of their effect on bone healing. CONCLUSION: An optimal preoperative, perioperative, and postoperative anesthesia and analgesia protocol is important to best possible pain relief and rapid return to normal function. Communication between the anesthesiologist and spine surgeon is important to achieve a protocol with the best short- and long-term outcomes for the benefit of the patient.