The effect of multimodal analgesia on intraoperative morphine requirement in lumbar spine surgeries

Abstract

Background:Lumbar spine surgery demands intense analgesia. Preemptive multimodal analgesia (MMA) is a novel approach to attenuate the stress response to surgical stimulus.Aims:The aim of the study was to assess the intraoperative morphine consumption in patients undergoing lumbar spine surgery.Patients and Methods:A randomized, prospective, double-blind study involving 42 patients belonging to the American Society of Anesthesiologists Class I and II scheduled to undergo elective lumbar spine surgery were allocated into two groups of 21 each. Group A (study group) received injection diclofenac sodium, paracetamol, clonidine, and skin infiltration with bupivacaine adrenaline and Group B (control group) received paracetamol and skin infiltration with saline adrenaline. Preemptive analgesia was practiced in both the groups. Intraoperative morphine consumption was documented.Statistical Methods:Intraoperative morphine consumption between the two groups was compared using Mann–Whitney U-test. Postextubation sedation score between the two groups was compared using Chi-square test and presented as number and percentage. P < 5% was considered statistically significant.Results:Intraoperative morphine consumption was significantly low in the study group (P < 0.001). Postextubation sedation score was comparable between the two groups.Conclusion:Preemptive MMA has demonstrated significant morphine sparing effect intraoperatively in patients undergoing lumbar spine surgeries.

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“…technique and judgemental of the analgesic requirements. Unbalanced anaesthesia leads to unacceptable haemodynamic changes by aggravating the sympathetically induced stress response during certain steps like intubation, noxious stimulus and extubation [14]. Similarly, Vikram et al compared multimodal analgesia including local anaesthesia infiltration with conventional analgesic regimen mainly IV paracetamol in lumbar spine surgery as regards the haemodynamic responses to intubation, change of position and noxious surgical incision.…”

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“…Effective multimodal methods for spine surgery may include the use of preemptive analgesia with non-steroidal anti-inflammatory drugs (NSAIDs), gabapentinoids (gabapentin and pregabalin), acetaminophen, and local anesthesia 12. Preemptive analgesia may improve patient satisfaction and quality of life by reducing postoperative pain narcotic consumption 6,7,13. Preemptive analgesia is a term that refers to treatment that starts before surgery, and is intended to prevent central sensitization caused by surgical incisional injury and other inflammatory responses to surgery 14.…”

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“…Parecoxib, a selective COX-2 inhibitor has been shown to be effective in managing postoperative dental pain with decreased incidence of gastroduodenal ulcers compared to nonselective COX inhibitors (14). Savitha and colleagues found NSAID administration decreased the use of intraoperative morphine in patients undergoing lumbar spinal surgery (15). In the urologic space, Mehta and colleagues studied the utility of pre-operative celecoxib administration on patients undergoing testicular surgery and compared it to their control group.…”