Comparison of Perioperative Oral Multimodal Analgesia Versus IV PCA for Spine Surgery

Abstract

This quality improvement study shows some safety and significant advantages of a multimodal perioperative oral analgesic regimen compared with standard IV PCA after spine surgery.

Postoperative Pain and Other Acute Pain Syndromes

“…14,15 Multimodal pain control strategies for certain procedures could become an integral part of clinical pathways to provide effective postoperative analgesia and rehabilitation. 16,17 …”

Preoperative and Postoperative Anesthetic and Analgesic Techniques for Minimally Invasive Surgery of the Spine

“…Most of the clinical trials have used oral 600 mg of gabapentin before surgery (1 hour before surgery) and continued (gabapentin at 600 mg 2 or 3 times a day) for the next 5 to 14 days depending on the extent of surgical trauma. 30 Pregabalin at a dose of 100 to 150 mg before surgery and continued in the postoperative period at a dose of 75 mg twice a day has been used in multiple joint replacement surgical patients and resulted in decreased acute and chronic pain in randomized controlled designs. 31 However, at this point, the exact dosing and duration need to be properly established to avoid the sedative side effects of gabapentinoids.…”

Multimodal Analgesia in Spine Surgery: A Commentary

“…Similarly, retrospective studies by Mathiesen, et al [6] and Rajpal, et al [39] demonstrated decreased total narcotic consumption and lower pain scores, as well as fewer adverse side effects such as nausea, vomiting, constipation, drowsiness, coughing and difficulty with deep breathing. An added benefit that has been demonstrated with MMA is shorter time to mobilization and reduced length of hospital stays [6,40] Despite decreased narcotic utilization with MMA protocols, total cost of medication has been reported to be similar between MMA and PCA groups [39]. However, this analysis did not take in to account the up front cost of equipment needed with PCA.…”