Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

Devin, Clinton J.; McGirt, Matthew J.

doi:10.1016/j.jocn.2015.01.003

Cited by 203 publications

(145 citation statements)

References 77 publications

Supporting

Mentioning

135

Contrasting

Unclassified

Order By: Relevance

“…Applying this pursuit to postoperative care, recovery from spine surgery is oriented toward restoring functional health outcomes while reducing hospital length of stay (LOS) and medical expenditures. Optimal pain management in this population is a key to reaching these objectives, in addition to reducing the potential for chronic use of opioids 3 . The use of long-acting opioids for post-surgical pain has been demonstrated to be associated with increased health care utilization and costs 4 .…”

Section: Introductionmentioning

confidence: 99%

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Hansen

Pham

Boing

et al. 2017

Current Medical Research and Opinion

View full text Add to dashboard Cite

Background: Recovery from spine surgery is oriented toward restoring functional health outcomes while reducing resource use. Optimal pain management is a key to reaching these objectives. We compared outcomes of spine surgery patients who received standard pain management including intravenous (IV) acetaminophen (APAP) vs. oral APAP. Methods: We performed a retrospective analysis of the Premier database (January 2012 to September 2015) comparing spine surgery patients who received pain management with IV APAP to those who received oral APAP, with no exclusions based on additional pain management. We performed multivariable logistic regression for the discharge and all cause 30-day readmission to the same hospital outcomes and instrumental variable regressions using the quarterly rate of IV APAP use for all hospitalizations by hospital as the instrument in two-stage least squares regressions for length of stay (LOS), hospitalization costs, and average daily morphine equivalent dose (MED) outcomes. Models adjusted for age, gender, race, admission type, 3M All Patient Refined Diagnosis Related Group severity of illness and risk of mortality, hospital size, and indicators for whether the hospital was an academic center and whether it was urban or rural. Results: We identified 112,586 spine surgery patients with 51,835 (46%) having received IV APAP. Subjects averaged 57 and 59 years of age respectively in the IV APAP and oral APAP cohorts and were predominantly non-Hispanic Caucasians and female. In our adjusted models, IV APAP was associated with 0.68 days shorter LOS (95% CI: À0.76 to À0.59, p < .0001), $1175 lower hospitalization costs (95% CI: À$1611 to À$739, p < .0001), 13 mg lower average daily MED (95% CI: À14 mg to À12 mg, p < .0001), 34% lower risk of discharge to a skilled nursing facility (95% CI: 0.63 to 0.69, p < .0001), and 13% less risk of 30-day readmission (95% CI: 0.73 to 1.03). Conclusions: Compared to oral APAP, managing post-spine-surgery pain with IV APAP is associated with less resource use, lower costs, lower doses of opioids, and improved discharge status.

show abstract

Section: Introductionmentioning

confidence: 99%

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Hansen

Pham

Boing

et al. 2017

Current Medical Research and Opinion

View full text Add to dashboard Cite

show abstract

“…The demand for major spinal surgery is increasing, and there are wide variations in length of stay (LOS), complication rates, post-operative pain and functional recovery. Spinal procedures are often associated with especially high levels of pain on the first post-operative day [30]. Lumbar fusion (1-2 levels), lumber fusion (3 or more levels) and complex spinal reconstruction were 3 of the 6 most painful procedures in Gerbershagen et al's [31] review of pain intensity across 179 different surgical procedures.…”

Section: Eras In Major Spinal Surgerymentioning

confidence: 99%

“…A review of the evidence for multimodal pain management in spinal surgery [30] found good evidence to support the use of many of the agents used in multimodal therapy, and there is a comprehensive chapter within this edition dedicated to the topic. Multimodal pain management techniques are a vital component of ERAS pathways, and when combined with other ERAS elements have been successful in accelerating recovery across a range of surgical procedures.…”

Section: Multimodal Pain Managementmentioning

confidence: 99%

Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery

Wainwright

Immins

Middleton

2016

Best Practice & Research Clinical Anaesthesiology

183

120

View full text Add to dashboard Cite

“…Although multimodal analgesia is the recommended strategy for postoperative analgesia, there is no consensus on the appropriate multimodal analgesia protocols or algorithms 43 . Further studies should be directed towards conducting functional analgesic treatment that will refl ect the appropriate eff ects of pain relief strategies.…”

Section: Fig 1 Diff Erences In Pain Perception Between Study Groupsmentioning

confidence: 99%

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

Kurtović

Rotim

Batinica³

et al. 2017

acc

View full text Add to dashboard Cite

SUMMARY -Lumbar discectomy is the most common surgical treatment for intervertebral disc extrusion. Postoperative pain is a common clinical problem that greatly aff ects the length of hospitalization, functional status and patient quality of life. Th e aim of this study was to compare the postoperative analgesic effi cacy of paracetamol administered intermittently and through patient-controlled analgesia (PCA) pump following single level lumbar discectomy. Patients who underwent elective lumbar discectomy of intervertebral disc extrusion at the L4-L5 level diagnosed by magnetic resonance of the lumbosacral spine were included in the study. Pain was assessed at regular intervals for 48 hours through a shortened version of McGill pain questionnaire translated in the Croatian language. When pain was monitored as a summarized variable for each measurement, PCA group signifi cantly stood up after 24 hours with better perception of pain compared to the intermittent group (c 2 -test, p<0.05). Adequate pain relief is an important aspect of postoperative care in spinal surgery patients. Postoperative use of paracetamol through PCA pump achieved better pain control and pain management versus postoperative use of intermittent paracetamol analgesia after lumbar discectomy.

show abstract

Best evidence in multimodal pain management in spine surgery and means of assessing postoperative pain and functional outcomes

Cited by 203 publications

References 77 publications

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Comparative analysis of length of stay, hospitalization costs, opioid use, and discharge status among spine surgery patients with postoperative pain management including intravenous versus oral acetaminophen

Enhanced recovery after surgery (ERAS) and its applicability for major spine surgery

Analgesic Effect – Comparison of Paracetamol Administered Intermittently and Through Patient-Controlled Analgesia Pump after Lumbar Discectomy: a Prospective Clinical Study

Contact Info

Product

Resources

About