A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study.

Authors

• Michael Markowitz
• Barrett Woods
• Gregory Schroeder
• Christopher Kepler
• David Kaye
• Mark Kurd
• Joshua Armstrong
• Alexander Vaccaro
• Kris Radcliff

Publication/Presentation Date

12-26-2023

Abstract

BACKGROUND: There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.

METHODS: The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.

RESULTS: There were 87 patients in the preprotocol cohort and 184 in the protocol cohort. Comparing protocol and preprotocol patients, there were no significant differences in patient demographics. There was significantly average lower pain in the protocol group on postoperative day (POD) 1 (4.50 vs 5.00,

CONCLUSION: Our novel multimodal pain management protocol significantly reduced postoperative pain, length of stay, and opioid consumption in this patient cohort. Opioid usage correlated to pain in the protocol patients, while the preprotocol patients had no correlation between opioid use and pain medication.

CLINICAL RELEVANCE: In this study, we demonstrated that preoperative and intraoperative analgesia can reduce postoperative pain medication requirements. Furthermore, we introduced a novel concept of a correlation of pain with opioid consumption as a marker of effective pain management of breakthrough pain.

Volume

17

Issue

6

First Page

828

Last Page

834

ISSN

2211-4599

Published In/Presented At

Markowitz, M., Woods, B., Schroeder, G., Kepler, C., Kaye, D., Kurd, M., Armstrong, J., Vaccaro, A., & Radcliff, K. (2023). A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study. International journal of spine surgery, 17(6), 828–834. https://doi.org/10.14444/8484

Disciplines

Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods

PubMedID

37673683

Department(s)

Administration and Leadership

Document Type

Article