Implementation of a Standardized Multimodal Postoperative Analgesia Protocol Improves Pain Control, Reduces Opioid Consumption, and Shortens Length of Hospital Stay After Posterior Lumbar Spinal Fusion

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 130-136 ◽  
Author(s):  
Corey T Walker ◽  
David M Gullotti ◽  
Virginia Prendergast ◽  
John Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Spinal Fusion ◽  
Pain Control ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Evidence Based ◽  
Lumbar Spinal Fusion ◽  
Pain Scores ◽  
Lumbar Spinal

Abstract BACKGROUND Multimodal analgesia regimens have been suggested to improve pain control and reduce opioid consumption after surgery. OBJECTIVE To institutionally implement an evidence-based quality improvement initiative to standardize and optimize pain treatment following neurosurgical procedures. Our goal was to objectively evaluate efficacy of this multimodal protocol. METHODS A retrospective cohort analysis of pain-related outcomes after posterior lumbar fusion procedures was performed. We compared patients treated in the 6 mo preceding (PRE) and 6 mo following (POST) protocol execution. RESULTS A total of 102 PRE and 118 POST patients were included. The cohorts were well-matched regarding sex, age, surgical duration, number of segments fused, preoperative opioid consumption, and baseline physical status (all P > .05). Average patient-reported numerical rating scale pain scores significantly improved in the first 24 hr postoperatively (5.6 vs 4.5, P < .001) and 24 to 72 hr postoperatively (4.7 vs 3.4, P < .001), PRE vs POST, respectively. Maximum pain scores and time to achieving appropriate pain control also significantly improved during these same intervals (all P < .05). A concomitant decrease in opioid consumption during the first 72 hr was seen (110 vs 71 morphine milligram equivalents, P = .02). There was an observed reduction in opioid-related adverse events per patient (1.31 vs 0.83, P < .001) and hospital length of stay (4.6 vs 3.9 days, P = .03) after implementation of the protocol. CONCLUSION Implementation of an evidence-based, multimodal analgesia protocol improved postoperative outcomes, including pain scores, opioid consumption, and length of hospital stay, after posterior lumbar spinal fusion.

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Neurosurgery ◽  
2020 ◽  
Vol 87 (3) ◽  
pp. 592-601 ◽  
Author(s):  
Arpan A Patel ◽  
Corey T Walker ◽  
Virginia Prendergast ◽  
John J Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Pain Scores ◽  
High Consumption ◽  
Lumbar Spinal

Abstract BACKGROUND Optimal postoperative pain control is critical after spinal fusion surgery. There remains significant variability in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and few data evaluating its utility compared with nurse-controlled analgesia (NCA) among patients with lumbar fusion. OBJECTIVE To investigate the efficacy of postoperative PCA compared with NCA to improve opiate prescription practices. METHODS A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients were divided into cohorts on the basis of postoperative treatment with PCA or NCA. Postoperative pain scores, length of stay, and total opioid consumption data were collected. Patients were stratified according to preoperative opioid consumption as opioid naive (0 morphine milligram equivalents [MME] daily), low consumption (1-60 MME), high consumption (61-90 MME), or very high consumption (>90 MME). RESULTS A total of 240 patients were identified, including 62 in the PCA group and 178 in the NCA group. PCA patients had higher mean preoperative opioid consumption than NCA patients (49.2 vs 24.3 MME, P = .009). PCA patients had higher mean opioid consumption in the first 72 h in all 4 of the preoperative opioid consumption subcategories. Pain control and adverse event rates were similar between PCA and NCA in the low to high preoperative opioid consumption groups. CONCLUSION Postoperative PCA is associated with significantly more opioid consumption in the first 72 h after surgery and equal or worse postoperative pain scores compared with NCA after lumbar spinal fusion surgery.

scholarly journals Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery

2020 ◽  
Vol 9 (4) ◽  
pp. 1087
Author(s):  
Sung-Woo Choi ◽  
Hyeung-Kyu Cho ◽  
Suyeon Park ◽  
Jae Hwa Yoo ◽  
Jae Chul Lee ◽  
...  
Keyword(s):  
Side Effects ◽  
Hospital Stay ◽  
Pain Score ◽  
Pain Control ◽  
Lumbar Fusion ◽  
Length Of Hospital Stay ◽  
Multimodal Analgesia ◽  
Opioid Consumption ◽  
Patient Controlled Analgesia ◽  
Posterior Lumbar Fusion

A multimodal analgesic method was known to avoid the high-dose requirements and dose-dependent adverse events of opioids, and to achieve synergistic effects. The purpose of this study was to compare the efficacy of our multimodal analgesia (MMA) regimen with that of the patient-controlled analgesia (PCA) method for acute postoperative pain management. Patients who underwent one or two-level posterior lumbar fusion (PLF) followed by either MMA or PCA administration at our hospital were compared for pain score, additional opioid and non-opioid consumption, side effects, length of hospital stay, cost of pain control, and patient satisfaction. From 2016 through 2017, a total 146 of patients were screened. After propensity score matching, 66 remained in the PCA and 34 in the MMA group. Compared with the PCA group, the MMA group had a shorter length of hospital stay (median (interquartile range): 7 days (5–8) vs. 8 (7–11); P = 0.001) and lower cost of pain control (70.6 ± 0.9 USD vs. 173.4 ± 3.3, P < 0.001). Baseline data, clinical characteristics, pain score, additional non-opioid consumption, side effects, and patient subjective satisfaction score were similar between the two groups. The MMA seems to be a good alternative to the PCA after one or two-level PLF.

scholarly journals S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: a randomized, double-blind, placebo-controlled clinical trial

2021 ◽  
Author(s):  
Elina C.V. Brinck ◽  
Taru Virtanen ◽  
Sanna Mäkelä ◽  
Venla Soini ◽  
Ville-Veikko Hynninen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Controlled Clinical Trial ◽  
Dependent Manner ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

AbstractBACKGROUNDSpinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.METHODSWe randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml−1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.RESULTSOf the 100 patients analyzed, patients receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml−1 (74.7 mg) or 0.25 mg ml−1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: −20.6 mg; 95% confidence interval [CI]: −41 to −0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups.CONCLUSIONSOxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

scholarly journals Ultrasound-Guided Anterior Quadratus Lumborum Block Reduces Postoperative Opioid Consumption and Related Side Effects in Patients Undergoing Total Hip Replacement Arthroplasty: A Propensity Score-Matched Cohort Study

2021 ◽  
Vol 10 (20) ◽  
pp. 4632
Author(s):  
Yeon-Ju Kim ◽  
Hyung-Tae Kim ◽  
Ha-Jung Kim ◽  
Pil-Whan Yoon ◽  
Ji-In Park ◽  
...  
Keyword(s):  
Side Effects ◽  
Propensity Score ◽  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Opioid Consumption ◽  
Ultrasound Guided ◽  
Pain Scores ◽  
Quadratus Lumborum Block ◽  
Replacement Arthroplasty ◽  
Quadratus Lumborum

Quadratus lumborum block (QLB) has been shown to be effective for pain relief after hip surgery. This study evaluated the efficacy of ultrasound-guided anterior QLB in pain control after total replacement hip arthroplasty (TRHA). A total of 115 patients receiving anterior QLB were propensity score-matched with 115 patients who did not receive the block. The primary outcome was opioid consumption at 24, 24–48, and 48 postoperative hours. Secondary outcomes included pain scores at the post-anesthesia care unit (PACU), 8, 16, 24, 32, 40, and 48 h length of hospital stay, time to first ambulation, and the incidence of opioid-related side effects. Postoperative opioid consumption 48 h after surgery was significantly lower in the QLB group. Resting, mean, worst, and the difference of resting pain scores compared with preoperative values were significantly lower in the QLB group during the 48 postoperative hours. The length of hospital stay was shorter in the QLB group. The incidence of postoperative nausea and vomiting was significantly lower in the QLB group during the 48 postoperative hours, except at the PACU. This study suggests that anterior QLB provides effective postoperative analgesia for patients undergoing THRA performed using the posterolateral approach.

149. Opioid sparing anesthesia for lumbar spinal fusion surgery reduces opioid consumption, blood loss and operative time: A propensity matched analysis

2021 ◽  
Vol 21 (9) ◽  
pp. S74-S75
Author(s):  
Jeffrey L. Gum ◽  
Leah Y. Carreon ◽  
Benjamin M. Sampedro ◽  
Jennifer Harpe-Bates ◽  
Tino Mkorombindo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Spinal Fusion ◽  
Operative Time ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Opioid Sparing ◽  
Lumbar Spinal

Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events

Neurosurgery ◽  
2021 ◽  
Vol 89 (Supplement_2) ◽  
pp. S13-S13
Author(s):  
Arpan A Patel ◽  
Corey T Walker ◽  
Virginia Prendergast ◽  
John J Radosevich ◽  
Doneen Grimm ◽  
...  
Keyword(s):  
Adverse Events ◽  
Spinal Fusion ◽  
Opioid Consumption ◽  
Lumbar Spinal Fusion ◽  
Patient Controlled Analgesia ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal
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