Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion

Bohl, Daniel D.; Louie, Philip K.; Shah, Neal; Mayo, Benjamin C.; Ahn, Junyoung; Kim, Tae‐Dong; Massel, Dustin H.; Modi, Krishna; Long, William W.; Buvanendran, Asokumar; Singh, Kern

doi:10.1097/brs.0000000000001380

Cited by 39 publications

(28 citation statements)

References 18 publications

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“…Although rescue opioid usage tended to be lower in the MMA group, the difference did not reach statistical significance. In addition, although the regimen for each MMA protocol is different, the side effects with MMA are typically less common than with PCA [15,16,19]. We had hypothesized that postoperative nausea and vomiting (PONV) would be less common in the MMA group.…”

Section: Discussionmentioning

confidence: 99%

“…PCA refers to any method that allows the patient to self-administer intravenous narcotic medication. Although highly effective at relieving pain, narcotic analgesics can have severe side effects, including nausea, vomiting, confusion, constipation, urinary retention, dizziness, sedation, respiratory depression, and pruritus [15,16]. Multimodal analgesia (MMA) is a good alternative to PCA.…”

Section: Introductionmentioning

confidence: 99%

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

Choi

Cho

Park

et al. 2020

JCM

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Choi

Cho

Park

et al. 2020

JCM

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“…Traditionally, patient-controlled analgesia (PCA) has been identified as effective in postoperative pain management and is the most frequently used analgesic method for spine surgery [ 4 , 5 ]. However, the main drug used is opioid analgesics, which have severe side effects including nausea or vomiting, confusion, urinary retention, sedation, respiratory depression, and pruritus [ 6 ]. Therefore, finding other analgesic strategies with fewer potentially adverse effects will be beneficial for patients suffering from postoperative pain.…”

Section: Introductionmentioning

confidence: 99%

Wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia for transforaminal lumbar interbody fusion: a retrospective study

Luo

et al. 2020

BMC Anesthesiol

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Background Surgical procedure usually causes serious postoperative pain and poor postoperative pain management negatively affects quality of life, function and recovery time. We aimed to investigate the role of wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia (PCA) in postoperative pain control for patients undergoing transforaminal lumbar interbody fusion. Methods One hundred twelve patients undergoing lumbar fusion were retrospectively reviewed and divided into two groups (ropivacaine and control groups) according to whether received wound infiltration with ropivacaine or not. Visual Analogue Scale (VAS) score, analgesics consumption, number of patients requiring rescue analgesic, hospital duration and incidence of complications were recorded. Surgical trauma was assessed using operation time, intraoperative blood loss and incision length. Results The amount of sufentanil consumption in ropivacaine group at 4 h postoperatively was lower than that of control group (24.5 ± 6.0 μg vs 32.1 ± 7.0 μg, P < 0.001) and similar results were observed at 8, 12, 24, 48 and 72 h postoperatively(P < 0.001). Fewer patients required rescue analgesia within 4 to 8 h postoperatively in ropivacaine group (10/60 vs 19/52, P = 0.017). Length of postoperative hospital durations were shorter in patients receiving ropivacaine infiltration compared to control cohorts (6.9 ± 0.9 days vs 7.4 ± 0.9 days, P = 0.015). The incidence of PONV in ropivacaine group was lower than that in control group (40.4% vs 18.3%, P = 0.01). However, VAS scores were similar in two groups at each follow-up points postoperatively, and no difference was observed(P > 0.05). Conclusion Wound infiltration with ropivacaine effectively reduces postoperative opioid consumption and PONV and may be a useful adjuvant to PCA to improve recovery for patients undergoing lumbar spine surgery.

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“…Leading etiologies of SCI include motor vehicle accidents, falls, violent acts, and contact sports [4]. Health care costs stem from greater payments required for acute care in intensive care unit facilities, higher rates of complications related to the injury, rehabilitation and health services [5].…”

Section: Introductionmentioning

confidence: 99%

Impact of Surgical Timing and Approaches to Health Care Utilization in Patients Undergoing Surgery for Acute Traumatic Cervical Spinal Cord Injury

Sharma

Dietz

Ugiliweneza

et al. 2019

Cureus

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Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion

Abstract: 3.

Cited by 39 publications

References 18 publications

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

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

Wound infiltration with ropivacaine as an adjuvant to patient controlled analgesia for transforaminal lumbar interbody fusion: a retrospective study

Impact of Surgical Timing and Approaches to Health Care Utilization in Patients Undergoing Surgery for Acute Traumatic Cervical Spinal Cord Injury

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