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Complex Spine 

Complex Spine
Complex Spine
Acute Pain Medicine

David A. Edwards

, and Christopher Sobey


Patients undergoing extensive spine surgery suffer from significant pain throughout the perioperative period. Of note, many patients utilize opioid medications preoperatively, which increases the risk of postoperative pain and numerous other risks. This chapter describes how central sensitization plays an essential role throughout the perioperative period and should be considered when planning tailored analgesic regimens. The chapter also details how NMDA antagonists such as ketamine can be used in the postoperative setting to reduce pain intensity and decrease opioid use. It concludes with a discussion of how the risk of opioid-induced ventilatory impairment can be managed postoperatively, including with nursing evaluation for somnolence and sedation at regular intervals in the first 4 hours after discharge from the postanesthesia care unit.

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