Perioperative factors associated with severe early postoperative pain after single-level lumbar discectomy: A retrospective cohort study

and lumbar discectomy remains one of the most commonly performed spinal procedures when conservative treatment fails. Despite advances in surgical technique and perioperative management, postoperative pain—particularly during the early postoperative period—remains clinically relevant. Severe pain within the first 24 hours after surgery may delay mobilization, increase opioid requirements, and complicate recovery. However, perioperative factors associated with severe early postoperative pain following elective single-level lumbar discectomy remain incompletely understood.Methods: This retrospective cohort study included adult patients undergoing elective single-level lumbar discectomy under general anesthesia. Postoperative pain intensity was assessed using the maximum numeric rating scale score recorded within the first 24 hours. Severe pain was defined as a score ≥7. Demographic, operative, and analgesic variables, including operative duration, intraoperative opioid exposure (fentanyl equivalents), multimodal analgesia, and rescue opioid use, were analyzed. Univariable and multivariable logistic regression analyses identified factors independently associated with severe early postoperative pain.Results: Among 322 patients, 78 (24.2%) experienced severe early postoperative pain. Longer operative duration (adjusted odds ratio 1.38 per 10-minute increase), higher intraoperative opioid exposure (adjusted odds ratio 1.29 per 50 microgram increase), absence of multimodal analgesia (adjusted odds ratio 0.46), and post-anesthesia care unit rescue opioid administration (adjusted odds ratio 3.12) were independently associated with severe pain within the first 24 hours.Conclusions: Severe early postoperative pain after single-level lumbar discectomy is common and is influenced by perioperative factors. Optimizing multimodal analgesia and limiting intraoperative opioid exposure may improve outcomes.