Preemptive Strike in Spinal Surgery
A new study shows that patients can get pain relief in the first 24 hours after spine surgery. The treatment is an injection of a local anesthetic into the epidural space of the spine. This is an example of preemptive analgesia. Preemptive analgesia involves treating pain before it happens. Preemptive analgesia works by preventing pain signals from reaching the nervous system and causing oversensitivity to the pain signal.

Two groups of patients were tested. The control group got an injection of a saline solution. There was no pain reliever. The study group received the injected analgesic. In both groups the injection was given at least 20 minutes before the operation started. All patients had a disc removed.

Pain was first measured when the patients woke up from the operation. It was measured again at four, eight, 12, and 24 hours after the surgery. The researchers found better pain relief in the study group. The study group also went longer before asking for any pain medication.

The authors conclude that pain control after spine surgery can be done preemptively. Patients can get safe and effective pain relief with one injection before the operation. Some pain is still present, so patients may still report problems early on. The authors suggest using an epidural injection of bupivacaine (anesthetic) and tramadol (narcotic).
C. Sekar, MD, et al. Preemptive Analgesia for Postoperative Pain Relief in Lumbosacral Spine Surgeries: A Randomized Controlled Trial. In The Spine Journal. May/June 2004. Vol. 4. No. 3. Pp. 261-264.