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Postoperative Pain Management After Lumbar Discectomy. A Systematic Review With Meta-Analyses and Trial Sequential Analyses

Zachodnik, Josephine LU ; Bech-Azeddine, Rachid ; Sandberg, Magnus LU orcid ; Scherwin, Rebecca ; Hartvigsen Grønholm Jepsen, Rikke Malene ; Jørgensen, Louise Møller ; Thybo, Kasper Højgaard and Geisler, Anja LU orcid (2026) In European Journal of Pain 30(4).
Abstract

Background: Inadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects. Objective: To identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy. Databases and Data Treatment: This systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with... (More)

Background: Inadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects. Objective: To identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy. Databases and Data Treatment: This systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE. Results: A total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions—including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin—were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia. Conclusions: Multiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice. Significance: The findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.

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author
; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
European Journal of Pain
volume
30
issue
4
article number
e70261
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:105035343520
  • pmid:41960853
ISSN
1090-3801
DOI
10.1002/ejp.70261
language
English
LU publication?
yes
id
7f2acd85-5821-48d4-8085-843761e5616d
date added to LUP
2026-04-28 13:00:34
date last changed
2026-06-09 15:43:57
@article{7f2acd85-5821-48d4-8085-843761e5616d,
  abstract     = {{<p>Background: Inadequate postoperative pain management after lumbar discectomy may delay recovery, increase the risk of chronic pain, and prolong hospitalization. Effective analgesic strategies must balance pain control with minimal adverse effects. Objective: To identify the most effective postoperative analgesic interventions for patients undergoing lumbar discectomy. Databases and Data Treatment: This systematic review was preregistered in PROSPERO and conducted in accordance with PRISMA guidelines. Randomized controlled trials were identified through systematic searches in Medline, Embase, and the Cochrane Library. The primary outcome was opioid consumption within 24 h postoperatively. Meta-analyses were conducted using RevMan, with Trial Sequential Analysis (TSA) to adjust for random errors. Risk of bias was assessed using ROB2, and certainty of evidence was evaluated with GRADE. Results: A total of 76 RCTs comprising 5617 participants were included, covering 11 analgesic strategies. Paracetamol, NSAIDs, epidural and intrathecal anaesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid consumption. Several interventions—including paracetamol, NSAIDs, glucocorticoids, ketamine, epidural and intrathecal anaesthetics, local anaesthetics, nerve blocks, gabapentin, and pregabalin—were also associated with lower pain scores at 6 and 24 h. However, evidence certainty ranged from low to very low due to methodological limitations, small sample sizes, heterogeneity, and inconsistent baseline analgesia. Conclusions: Multiple analgesic strategies show potential for reducing opioid use and improving early postoperative pain control after lumbar discectomy. Nevertheless, the low certainty of evidence highlights the urgent need for high-quality, standardized trials to inform clinical practice. Significance: The findings demonstrate that the following analgesics significantly reduce supplemental opioid consumption and pain levels in the immediate postoperative period: PCM, NSAIDs, intrathecal anaesthetics, epidural anaesthetics, LIA/wound infiltration, nerve blockade, gabapentin, and pregabalin. However, the high risk of bias and low quality of evidence in many of the included trials necessitate cautious interpretation of the findings.</p>}},
  author       = {{Zachodnik, Josephine and Bech-Azeddine, Rachid and Sandberg, Magnus and Scherwin, Rebecca and Hartvigsen Grønholm Jepsen, Rikke Malene and Jørgensen, Louise Møller and Thybo, Kasper Højgaard and Geisler, Anja}},
  issn         = {{1090-3801}},
  language     = {{eng}},
  number       = {{4}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{European Journal of Pain}},
  title        = {{Postoperative Pain Management After Lumbar Discectomy. A Systematic Review With Meta-Analyses and Trial Sequential Analyses}},
  url          = {{http://dx.doi.org/10.1002/ejp.70261}},
  doi          = {{10.1002/ejp.70261}},
  volume       = {{30}},
  year         = {{2026}},
}