[Analgesia after surgery of the spine in adults and adolescents].

Postoperative pain after spinal surgeries is highly dependent on the number of vertebrae included in the operation and on its invasiveness, opposing two extremes, discectomies and cyphoscoliosis corrections. Opiates by intravenous route remain the reference, either continuously given in predetermined doses, or better using a patient-controlled device. Nonsteroidal and steroidal anti-inflammatory drugs are widely popular for medical approach of sciatalgia and it is quite logical to use them for reducing, even to suppress, opiates after spinal surgeries. Supported by many studies, spinal administration of analgesics (opiates, alpha 2-agonists, corticosteroids) may be of interest in pain treatment of spinal surgeries. In order to prolong locoregional analgesia, a catheter may be inserted into epidural space by caudal route or surgically, before skin closure. Morphine is the most popular agent in this indication. Also, epidural clonidine results in excellent pain relief, but is associated with hypotension and marked sedation. In discectomy, injection of dexamethasone into the operative field has been proposed. Whatever the technique used, early diagnosis of neurological complications of spinal surgery should be not ruled out by postoperative analgesia.