Title

A Retrospective Analysis of Trigger Point Injections in the Management of Post-surgical Pain in Patients who had Anterior Cervical Surgery

Document Type

Journal Article

Publication Date

2020

Journal

Journal of Clinical Research in Anesthesiology

Volume

33

Issue

2

Keywords

pain management; opioids; spinal surgery

Abstract

Introduction: The opioid epidemic has launched the United States into a public health crisis, resulting in a greater emphasis on non-opioid multimodal pain control methods. At our institution, post-operative posterior neck stiffness and myofascial pain are a common concern after anterior cervical surgery (ACS), likely due to prolonged intraoperative positioning in neck extension. Studies have shown successful analgesic outcomes of trigger point (TP) injections with local anesthetic for generalized myofascial pain. This retrospective pilot study aimed to evaluate whether TP injections with bupivacaine decrease post-surgical pain compared with traditional therapies in patients undergoing ACS and thereby decrease the amount of opioid medication used. Materials and Methods: We retrospectively reviewed all ACS cases from January 2019 to March 2020 at a single university hospital. We identified patients who received TP injections versus standard care (SC). Patients were excluded if TP was performed >3 h from surgery, in recovery for opioid use disorder, underwent a posterior approach, staged surgery, or sustained cervical trauma. The primary outcomes were pain control through the visual analog scale (VAS) and calculated oral morphine equivalents (OME) taken at 6, 12, and 24 h postoperatively. Secondary outcomes included length of stay. Results: A total of 137 patients received ACS (100 SC, 37 TP), 62 were excluded. A total of 75 (47 SC, 28 TP) patients were included in this study. The average OME at 6 h significantly decreased when comparing SC versus TP (32 vs. 22, P = 0.025). There was no significant difference in average VAS at all time points and average OME at 12 and 24 h. About 50% of patients were discharged by 18 h. Discussion: Within 6 h of the post-operative period, TP injections with bupivacaine significantly reduce opioid consumption, without affecting overall pain level. There is an opportunity for TP injections to be included in opioid-sparing, multimodal pain regimens for post-operative myofascial neck pain, especially in consideration of the opioid crisis. Limitations of this retrospective study were the small number of study participants that many patients were discharged before 18 h and that some may have been on chronic pain therapy. Conclusions: In this retrospective study, trigger point injections are an effective alternative method of pain control for myofascial neck pain in the immediate post-operative period after ACS, leading to decreased opioid consumption.

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