The Impact of Intraoperative and Postoperative Analgesic Regimens on Functional Mobility After Lumbar Spine Surgery: A Systematic Review and Meta-analysis

Study Design: Systematic review and meta-analysis. Objective: To assess the efficacy of intraoperative and postoperative analgesic regimens for improving postoperative mobility in patients undergoing lumbar spine surgery (LSS). Summary of Background Data: Mobilization is associated with improved outcomes in patients undergoing LSS. Effective pain management is essential, but there is no standardized analgesic protocol for optimizing mobility after LSS. Understanding the efficacy of various intraoperative and postoperative pain regimens may guide development of such protocols and improve functional outcomes in this population. Methods: A systematic literature search was conducted in MEDLINE, Embase, and Web of Science to query articles investigating the impact of intraoperative and postoperative analgesic regimens on functional mobility in LSS patients. Study characteristics, patient demographics, surgical indications, analgesic interventions, and functional mobility outcomes were extracted. Descriptive statistics and narrative analyses were performed to describe the impact of analgesic strategies on postoperative mobility. A meta-analysis was conducted to investigate the efficacy of intraoperative nerve blocks on reducing postoperative time to ambulation. Results: A total of 4631 studies were screened. Forty-four studies, encompassing 4252 patients, met inclusion criteria. Intraoperative analgesia (spinal and local nerve blocks) was the most common intervention showing significant improvements in postoperative mobility (n=10 studies). A meta-analysis demonstrated that patients who received adjunctive intraoperative analgesia (spinal or local nerve blocks) had significantly reduced time to ambulation compared with controls ( P =0.002). Multimodal medication-based approaches were associated with enhanced functional outcomes and reduced disability scores. Steroid injections and postoperative nerve blocks yielded mixed results. Conclusion: Optimizing postoperative pain interventions is crucial for successful rehabilitation after LSS. Our study emphasizes the benefit of intraoperative nerve blocks as adjuncts to promote early ambulation and functional recovery. Overall, a combination of intraoperative and postoperative therapies may be useful for promoting sustained improvements in mobility.