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Master Thesis

Prise en charge peropératoire de la douleur lors d’une laminectomie : revue de la littérature et recommandations du groupe PROSPECT = Pain management after laminectomy : a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Abstract : Purpose: With lumbar laminectomy increasingly being performed on an outpatient basis, optimal pain management is critical to avoid postoperative delay in discharge and readmission. The aim of this review was to evaluate the available literature and develop recommendations for optimal pain management after one or two-level lumbar laminectomy. Method: A systematic review utilizing the PROcedure SPECific Postoperative Pain ManagemenT (PROSPECT) methodology was undertaken. Randomised controlled trials (RCTs) published in the English language from 1 January 2008 until 31 March 2020 –assessing postoperative pain using analgesic, anaesthetic, and surgical interventions – were identified from MEDLINE, EMBASE and Cochrane Databases. Results: Out of 65 eligible studies identified, 39 RCTs met the inclusion criteria. The analgesic regimen for lumbar laminectomy should include paracetamol and a nonsteroidal antiinflammatory drug (NSAID) or cyclooxygenase (COX)–2 selective inhibitor administered preoperatively or intraoperatively and continued postoperatively, with postoperative opioids for rescue analgesia. In addition, surgical wound instillation or infiltration with local anaesthetics prior to wound closure is recommended. Some interventions – gabapentinoids and intrathecal opioid administration –, although effective, carry significant risks and consequently were omitted from the recommendations. Other interventions were also not recommended because there was insufficient, inconsistent or lack of evidence. Conclusion: Perioperative pain management for lumbar laminectomy should include paracetamol and NSAID or COX-2 selective inhibitor, continued into the postoperative period, as well as intraoperative surgical wound instillation or infiltration. Opioids should be used as rescue medication postoperatively. Future studies are necessary to evaluate the efficacy of our recommendations.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-03543933
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Submitted on : Wednesday, January 26, 2022 - 12:26:28 PM
Last modification on : Wednesday, March 16, 2022 - 3:37:28 AM
Long-term archiving on: : Wednesday, April 27, 2022 - 6:48:01 PM

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Pauline Le Cacheux. Prise en charge peropératoire de la douleur lors d’une laminectomie : revue de la littérature et recommandations du groupe PROSPECT = Pain management after laminectomy : a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03543933⟩

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