PROSPECT provides clinicians with supporting arguments for and against the use of various interventions in postoperative pain based on published evidence and expert opinion. Clinicians must make judgements based upon the clinical circumstances and local regulations. At all times, local prescribing information for the drugs referred to must be consulted.
Grades of recommendation are assigned according to the overall level of evidence on which the recommendations are based, which is determined by the quality and source of evidence: Relationship between quality and source of evidence, levels of evidence and grades of recommendation.
Complex spine surgery can be deﬁned as thoracolumbar spine surgery with instrumentation, laminectomy at three or more levels, or scoliosis surgery. Complex spine surgery is associated with intense postoperative pain, while adequate pain control can improve early postoperative rehabilitation and long-term outcomes (Lamperti 2017; Borgeat 2008).
The aim of this guideline is to provide clinicians with an evidence-based approach to pain management after complex spine surgery to improve postoperative outcomes such as early ambulation and discharge. The recommendations are based on a procedure-speciﬁc systematic review of randomised controlled trials and meta-analyses, with primary outcomes being postoperative pain scores and analgesic requirements. The methodology considers clinical practice, efﬁcacy and adverse effects of analgesic techniques.
COX, cyclooxygenase; IV, intravenous; NSAIDs, non-steroidal anti-inflammatory drugs.
Analgesic interventions that are not recommended for pain management in patients undergoing complex spine surgery.