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

Abstract

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.

The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery

“…Our PMPM protocol improved pain control on postoperative day 3, which was consistent with previous studies. Rajpal et al [19] reported that preventative multimodal analgesia improved pain control on all four postoperative days in patients undergoing lumbar fusion surgery, and Choi et al [9] found that multimodal analgesia reduced additional opioid use on postoperative day 2 without increasing pain levels in patients with one-or two-level posterior lumbar fusion surgery compared to a PCA group. In our study, more physical activity might contribute to the slightly increased VAS score and additional opioids' prescription on POD3 in the PMPM group; the analgesic pump would be turned off on POD3, which might contribute to a significantly increased VAS score in the control group.…”

“…Poor pain control is associated with patients' dissatisfaction [6], postoperative complications [7], and excessive opioid consumption [8]. Patient-controlled analgesia (PCA) and perioperative multimodal pain management (PMPM) (also known as multimodal analgesia) relive unnecessary suffering after fusion surgery [9]. PCA is a conventional method that allows the patients to self-administer intravenous opioid medication to control pain [10].…”

“…Given the side effects of opioids, effective multimodal medication regimens are needed to reduce postoperative opioid use and improve outcomes without increasing pain levels in older patients. Previous studies had demonstrated the associations between PMPM and outcomes including cost reduction, less morphine consumption, shorter length of hospitalization, and lower complications rates in various patient cohorts with an average age range of 50-70 years [9,[18][19][20][21]. However, few studies reported PMPM implementation in older patients undergoing lumbar fusion surgery.…”

Clinical Update on Patient-Controlled Analgesia for Acute Postoperative Pain

“…Several risk factors for high postoperative pain scores have been established [6,7]. Nearly all types of surgery that yield high postoperative pain can be treated with IV-PCA in the acute phase; examples of such surgeries include spine and other complex orthopedic surgeries, such as knee and hip [15], open abdominal [16] and non-ambulatory laparoscopic surgery [17]; and thoracic [18], major cervicofacial and reconstruction surgeries [19], including breast surgeries [20]. In addition to initial severe postoperative pain, some surgeries can also yield chronic postoperative pain such as cardiac [21], knee [22] shoulder [23] and hip pain [24].…”

Efficacy of Intravenous Ibuprofen and Acetaminophen on Postoperative Pain and Tramadol Consumption in Laparoscopic Cholecystectomy: Prospective, Randomized, Double-blinded Clinical Trial

“…Opioid use has been associated with severe adverse effects, including respiratory depression, postoperative pruritus, urinary retention, gastrointestinal events, sedation, and allergic reactions [9]. Combining nonsteroidal anti-inflammatory drugs (NSAIDs) with opioids may also reduce adverse effects and the required opioid dose [10][11][12][13]. The ASA Task Force on Acute Pain Management reports that opioids in combination with NSAIDs, COXIBs, or acetaminophen may be superior to opioid use alone [5].…”