Issues in chronic pain after spine surgery
microendoscopic v.s. open surgeries

Iwai Orthopaedic Medical Hospital
Takano Y, Baba S,Shiboi R, and Inanami H.
The Univ. of Tokyo
Oshima Y.
Teikyo Univ.
Iwahori T.
Keio Univ.
Iwai H.
Yuichi Takano M.D.

http://www.iwai.com[CDI開示] 今回の発表に関連し、開示すべきCOI関係にある企業などはありません。
Chronic pain 2013/9/7

Background•Tramadol/paracetamol 37.5 mg/325 mg (Tramacet,Zaldiar, Ixprim, Kolibri) is indicated in the EU for thesymptomatic treatment of moderate to severe pain,
including postoperative pain after spine surgery.
(Dhillon S. 2010)

Purpose•The purpose of this study was to investigate usage of
medicine for acute and chronic pain relief after spinesurgery.
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Materials & Methods• From March 2012 to June 2012, spine surgeries wereperformed in 428 patients with cervical and lumbar
degenerative disorders.
• All patients took non-steroidal anti-inflammatory
drugs (NSAIDs) postoperatively.
• Postoperative patient controled analgesia (PCA) wasused for cervical laminoplasty and ME-PLIF.
• NRS > 5 → Tramacet (4 times per day)• 34 out of 428 patients needed additional dosages ofTRAMACET® tablets instead of NSAIDs.
Chronic pain 2013/9/7

Procedures

Pt (n)

No. of Tramcet (n)％Cervical ASF ●

1100

BKP

600

Disc-Fx/enSpire/PLDD

1400

Cervical laminoplasty ●

63

50.0

MECD/MECL

33

39.1

MED

178

95.1

MEL

105

3

2.9

PELD

500

Microendoscopic PLIF (ME-PLIF)

63

1523.8Others (1 infection case)7114.3

Total (●open surgery)

428

347.9

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Tramacet medication after each spine surgery

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Tramacet medication and postoperative
hospitalization(days)

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Postoperative Tramacet medication in 34 cases
On medication★★

★

★ Preop medication★

★

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discontinuation

Tramacet medication and its side effects
Total 428
Tramacet administration
34

Postoperative patient
controled analgesia (PCA)
19
Discontinuation
for side effects
3 (8.8%)Chronic pain 2013/9/7

Pre & postoperative
Tramacet medication
8Medication after discontinuation of TramacetChronic pain 2013/9/7

Tramacet medication and its effects
Total 428
Tramacet 34
Discontinuation for side effects 3

Pain relief 26（mean 6.9 wks）

On medication 5(meam 32 wks)
Cervical laminectomy 1
Cervical foraminotomy 1
MED 1
2-level PLIF 1
Revision PLIF 1

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On medication in 5 cases
5 out of 34 continued taking tramadol more than postoperative
6 months.
1.Cervical laminectomy
2.Cervical foraminotomy
3.MED
4.2-level PLIF
5.Revision PLIF

dural tearpreoperative severe pain
dural tear
Multi-level fusion
Revision for non-union

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Tramadol/paracetamol fixed-dose combination: a review of its
use in the management of moderate to severe pain.
Dhillon S. (Clin Drug Investig. 2010;30(10):711-38)
Single- or multiple-dose tramadol/paracetamol was effective inpatients with postoperative pain, subacute lower back pain.
Tramadol/paracetamol is a useful treatment option for providing
multimodal analgesia in patients with moderate to severe pain.
Domestic clinical test at time of recognition in Japan(based on the medicinal action of opioid)
Nausea 41.4％
vimiting 26.2％
drowsiness 25.9％
constipation 21.2％unstability giddiness 18.9％
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Discussion（％）•Revision PLIF
100
•Infection PLIF
100
•Cervical laminoplasty50.0•ME-PLIF•MECD/MECL
9.1
•MED
5.1
•MEL
•PELD0•Cervical ASF
0•BKP•Disc-Fx/enSpire/PLDD

Open
Open
Open
23.8
2.9
00

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Microendoscopic
Microendoscopic
Microendoscopic
Microendoscopic
Microendoscopic
Open
Percutaneus
Percutaneus

Conclusion• NSAID was effective in most of patients with postoperative
moderate pain after spine surgeries.
• Tramacet medication instead of NSAID was effective in patientswith postoperative severe pain.
• The discontinuation rate of Tramacet was 8.8 % for side effect.
• Most patients who were on Tramacet medication more than 6months had preoperative severe pain, dural tear or non-union.

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