Opioid-sparing strategies for postoperative pain management in cancer patients with chronic pain syndrome undergoing spine fusion surgery

Postoperative analgesia in cancer patients with chronic pain syndrome (CPS) undergoing spine fusion surgery remains a complex clinical challenge due to multifactorial nature of pain and the risk of increased opioid burden. Objective. To summarize literature data on multimodal postoperative analgesia in cancer patients with emphasis on opioid-sparing approaches and infusion forms of non-steroidal anti-inflammatory drugs (NSAIDs). Material and methods. A narrative review with elements of systematic searching was performed using the PubMed and eLibrary databases. Results. Studies addressing CPS in malignant diseases, pain associated with metastatic spinal lesions and postoperative analgesia in spinal surgery including intravenous ibuprofen and a fixed combination of diclofenac with orphenadrine were analyzed. Literature data indicate that postoperative pain in these patients can include nociceptive, inflammatory, neuropathic, and muscle-tonic components. Conclusion. Infusion of NSAIDs is reasonable for multimodal opioid-sparing analgesic regimens. However, their efficacy and safety in cancer patients with CPS require further investigation.