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Postoperative Pain Management After Lumbar Discectomy. A Systematic Review With Meta-Analyses and Trial Sequential
Josephine Zachodnik1,2, Rachid Bech-Azeddine3, Magnus Sandberg2
1Centre for Anaesthesiological Research, Department of Anaesthesiology, Zealand University Hospital, Koege, Denmark.
European Journal of Pain (London, England)
|April 10, 2026
Summary
Effective postoperative pain management after lumbar discectomy involves multiple analgesic strategies, including paracetamol and NSAIDs, which significantly reduce opioid consumption. However, low-certainty evidence necessitates further high-quality trials for definitive clinical guidance.
Area of Science:
- Pain Management
- Anesthesiology
- Neurosurgery
Background:
- Inadequate pain control post-lumbar discectomy can impede recovery and increase chronic pain risk.
- Optimizing analgesia requires balancing efficacy with minimal adverse effects.
Purpose of the Study:
- To systematically review and identify effective postoperative analgesic interventions for lumbar discectomy patients.
- To assess the impact of various strategies on opioid consumption and pain scores.
Main Methods:
- Systematic review of 76 RCTs (5617 participants) adhering to PRISMA guidelines.
- Searches in Medline, Embase, and Cochrane Library; primary outcome: 24-h opioid consumption.
- Meta-analysis with Trial Sequential Analysis; risk of bias (ROB2) and evidence certainty (GRADE) assessed.
Main Results:
- Paracetamol, NSAIDs, epidural/intrathecal anesthetics, local infiltration, nerve blocks, gabapentin, and pregabalin significantly reduced 24-h opioid use.
- These interventions, plus glucocorticoids and ketamine, also lowered pain scores at 6 and 24 hours.
- Evidence certainty was low to very low due to methodological limitations and heterogeneity.
Conclusions:
- Multiple analgesic strategies show promise for reducing opioid use and improving early pain control after lumbar discectomy.
- Low certainty of evidence underscores the need for high-quality, standardized trials.
- Findings on specific analgesics (PCM, NSAIDs, etc.) require cautious interpretation due to trial quality concerns.
