Postoperative pain in the recovery room among patients undergoing lumbar spine surgery after implementing Khon Kaen University Procedure-Specific Pain Management (KKU PROSPECT) Guidelines

Abstract

Lumbar spine surgery commonly causes significant acute postoperative pain due to soft tissue, joint, and muscle injury. An institutional internal audit (2017–2019) showed that 70.5–74.4% of patients experienced moderate-to-severe pain (NRS ≥4) in the PACU. In 2020, we introduced the Khon Kaen University Procedure-Specific Pain Management for Spine Surgery (KKU PROSPECT) pathway to standardize analgesia for this population.  We conducted a retrospective descriptive study of 179 adults undergoing elective lumbar spine surgery at Srinagarind Hospital to assess early postoperative analgesic outcomes following pathway implementation. Data collected included baseline and operative variables, NRS scores on PACU arrival and before discharge, morphine consumption, analgesic modalities used, protocol adherence, and complications.  On arrival, the median NRS was 3 (IQR 0–7), with 45.8% reporting NRS ≥4; before discharge, 82.1% had none-to-mild pain. Median PACU morphine use was 6 mg (IQR 3–8), significantly lower in patients arriving with none-to-mild pain compared with those with moderate-to-severe pain (3 [1–6] vs 8 [6–10] mg; p<0.0001). No opioid-related complications were observed. Pathway adherence was complete in 38.6% of cases, incomplete due to contraindications in 29.1%, and incomplete without contraindications in 32.4%.  Implementation of the KKU PROSPECT pathway was associated with improved early postoperative pain control. Further gains may be achieved by increasing adherence (e.g., using prescriber prompts and simplified order sets), strengthening patient education, updating recommendations to reflect current evidence, and continuing systematic quality monitoring.