scholarly journals A Comparison of the Effects between Acetaminophen and Flurbiprofen after Lumbar Spinal Fusion Surgery

2019 ◽  
pp. 1-7
Author(s):  
Shigehiko Urabe ◽  
Yoshiaki Terao ◽  
Shozo Tominaga ◽  
Makito Oji ◽  
Makoto Fukusaki ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Spinal Fusion ◽  
Fixed Dose ◽  
Bolus Administration ◽  
Lumbar Spinal Fusion ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Analgesic Effects ◽  
Group A ◽  
Lumbar Spinal

Aims: Introduction: Spinal fusion surgery is often associated with severe postoperative pain. This study aimed to determine whether intravenous acetaminophen produces equivalent analgesic effects to flurbiprofen under fentanyl patient-controlled analgesia (PCA) after one-level lumbar spinal fusion surgery. Study Design: Rondomized controlled trial. Place and Duration of Study: Department of Anesthesia, Nagasaki Rosai Hospital, Sasebo Japan, between October 2015 to March 2017. Methodology: We studied 75 patients who underwent one-level lumbar spinal fusion surgery. Patients were randomly allocated to 1 of 3 groups: Group A (n = 25), which received 15 mg/kg acetaminophen intravenously every 6 hr. Group F (n = 25), which received 1 mg/kg flurbiprofen intravenously every 8 hr; and Group C (n = 25), which received saline every 6 hr as the control. Each drug was started from prior to skin closure to 24 hr after surgery. All patients received fentanyl at a fixed dose of 0.33 μg/kg/hr continuously after a bolus administration of 250 μg fentanyl. A bolus of 0.33 μg/kg of fentanyl was administered on demand by PCA (lockout interval 15 min). Postoperative pain was evaluated using a numerical rating scale (NRS) at 1, 2, 6, 12, 24 hr postoperatively and fentanyl consumption was recorded for 6 and 24 hr after surgery. The frequency of bolus fentanyl administration were also recorded. Results: There were no significant differences in NRS scores among the 3 groups. Acetaminophen and flurbiprofen did not show opioid sparing-effects under fentanyl PCA. However, the frequency of fentanyl boluses were significantly less in group A than in group C. Conclusions: Acetaminophen may produce equivalent analgesic effects to flurbiprofen after one-level lumbar spinal fusion surgery.

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 Local infiltration with cocktail analgesics during 2 level lumbar spinal fusion surgery

Medicine ◽  
2019 ◽  
Vol 98 (19) ◽  
pp. e15526
Author(s):  
Zhinan Ren ◽  
Zheng Li ◽  
Shugang Li ◽  
Lin Sheng ◽  
Derong Xu ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Lumbar Spinal Fusion ◽  
Local Infiltration ◽  
Fusion Surgery ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

scholarly journals Patient journey following lumbar spinal fusion surgery (LSFS): protocol for a multicentre qualitative analysis of the patient rehabilitation experience (FuJourn)

BMJ Open ◽  
2018 ◽  
Vol 8 (1) ◽  
pp. e020710 ◽  
Author(s):  
Alison Rushton ◽  
J Bart Staal ◽  
Martin Verra ◽  
Andrew Emms ◽  
Michael Reddington ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Phenomenological Analysis ◽  
Normal Function ◽  
Interpretive Phenomenological Analysis ◽  
Lumbar Spinal Fusion ◽  
Patient Journey ◽  
Fusion Surgery ◽  
Software Analysis ◽  
Spinal Fusion Surgery ◽  
Lumbar Spinal

IntroductionThere has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years, with costs of £26 million to the UK National Health Service annually. Patient dissatisfaction with outcome and persistent pain and disability incurs further costs. Three trials provide low-quality evidence for the role of physiotherapy. Our UK surveys investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. This study will explore the perceptions of patients who undergo LSFS to inform precision rehabilitation.Methods and analysisA qualitative study, using interpretive phenomenological analysis, will recruit a purposive sample (n=40) to ensure patterns of similarity and difference in their journeys can be explored. In-depth semistructured interviews will be undertaken following discharge from hospital and at 12 months postsurgery. Patients’ preoperative and postoperative experiences, underlying attitudes and beliefs towards the surgical intervention, facilitators and barriers to recovery, adherence to advice and physiotherapy, experiences of rehabilitation and return to normal function/activity/work will be explored. A 12-month patient diary will provide real time access to patient data, capturing a weekly record of life as lived, including symptoms, medication, experiences of stages of recovery, rehabilitation adherence, healthcare professional appointments, attitudes, their feelings and experiences throughout their journey. Data will be analysed in a number of stages in accordance with interpretive phenomenological analysis, supported using NVivo software. Analysis of the first interviews and patient diaries will afford a rich density of data to build an overall understanding of the patients’ lived experiences, informing the 12-month interview. Strategies (eg, reflexivity) will ensure trustworthiness.Ethics and disseminationThe study has ethical approval (IRAS 223283). Findings will ensure that patient-driven data inform precision rehabilitation by understanding the patient journey. Findings will be disseminated through peer-reviewed journals and conferences.

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