Beyond Opioid Patient-Controlled Analgesia: A Systematic Review of Analgesia After Major Spine Surgery

Reg Anesth Pain Med. Jan-Feb 2012;37(1):79-98. doi: 10.1097/AAP.0b013e3182340869.


Postoperative pain control in patients undergoing spine surgery remains a challenge for the anesthesiologist. In addition to incisional pain, these patients experience pain arising from deeper tissues such as bones, ligaments, muscles, intervertebral disks, facet joints, and damaged nerve roots. The pain from these structures may be more severe and can lead to neural sensitization and release of mediators both peripherally and centrally. The problem is compounded by the fact that many of these patients are either opioid dependent or opioid tolerant, making them less responsive to the most commonly used therapy for postoperative pain (opioid-based intermittent or patient-controlled analgesia). The purpose of this review was to compare all published treatment options available that go beyond intravenous opiates and attempt to find the best possible treatment modality.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Analgesia, Patient-Controlled* / adverse effects
  • Analgesics, Opioid / administration & dosage*
  • Analgesics, Opioid / adverse effects
  • Back Pain / etiology
  • Back Pain / prevention & control*
  • Evidence-Based Medicine
  • Humans
  • Orthopedic Procedures / adverse effects*
  • Pain, Postoperative / etiology
  • Pain, Postoperative / prevention & control*
  • Spine / surgery*
  • Treatment Outcome


  • Analgesics, Opioid