Opioid based Anesthesia in Spine Surgery

Abstract

Background: Opioid-based anesthesia (OBA) has traditionally played a central role in perioperative analgesia for spine surgery because these procedures are frequently associated with severe nociceptive stimulation and substantial postoperative pain. Opioids provide potent analgesia and sympatholysis through their actions on μ, κ, and δ opioid receptors at spinal and supraspinal levels, thereby suppressing nociceptive transmission and attenuating the surgical stress response. They are commonly used during induction and maintenance of anesthesia and for postoperative pain control because of their rapid onset, reliable efficacy, and ability to reduce anesthetic requirements. However, opioid administration is associated with important dose-dependent adverse effects, including respiratory depression, sedation, nausea and vomiting, gastrointestinal hypomotility, pruritus, urinary retention, tolerance, and dependence. Moreover, patients undergoing spine surgery may require substantial postoperative opioid consumption, particularly those with pre-existing chronic pain or previous opioid exposure, increasing concerns regarding persistent postoperative opioid use and unfavorable surgical outcomes. Therefore, appropriate opioid selection, careful dose titration, and consideration of multimodal analgesic approaches are essential to achieve effective perioperative pain control while minimizing opioid-related complications.