Therapeutic Effect of Intrathecal Morphine After Posterior Lumbar Interbody Fusion Surgery

Ziegeler, Stephan; Fritsch, Ekkehard; Bauer, Clemens; Mencke, Thomas; Müller, B.; Soltész, Stefan; Silomon, M.

doi:10.1097/brs.0b013e3181844ef2

Cited by 55 publications

(49 citation statements)

References 33 publications

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“…A number of studies have focused on pain treatment in spine surgery, but most studies have focused on primary degenerative conditions in the lumbar spine treated with discectomy, decompression and lumbosacral fusion [10,11]. Since an increased number of major spinal procedures, including revision surgery can be anticipated, we found it of relevance to assess a multimodal pain treatment strategy in patients undergoing surgery requiring instrumentation on [3 levels.…”

Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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Section: Introductionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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“…[5][6][7] Local infiltration of anesthetics in the surgical site during wound closure is commonly performed with lumbar spine surgery. 8,9 These agents are traditionally used to provide postoperative analgesia, but the effects are limited by dosing restrictions due to potential systemic side effects from peak plasma concentrations. 10 Furthermore, the duration of analgesia is limited by each anesthetic's halflife.…”

Section: Introductionmentioning

confidence: 99%

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

Brown¹,

Weir²,

Shasti³

et al. 2018

Int J Spine Surg

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Background: Postoperative pain management in spine surgery holds unique challenges. The purpose of this study is to determine if the local anesthetic liposomal bupivacaine (LB) reduces the total opioid requirement in the first 3 days following posterior lumbar decompression and fusion (PLDF) surgery for degenerative spondylosis.Methods: Fifty patients underwent PLDF surgery in a prospective randomized control pilot trial between August 2015 and October 2016 and were equally allocated to either a treatment (LB) or a control (saline) group. Assessments included the 72-hour postoperative opioid requirement normalized to 1 morphine milligram equivalent (MME), visual analog scale (VAS), and hospital length of stay.Results: LB did not significantly alter the 72-hour postoperative opioid requirement compared to saline (11.6 vs. 13.4 MME, P ¼ .40). In a subgroup analysis, there was also no significant difference in opioid consumption among narcotic-naive patients with either LB or saline. Among narcotic tolerant patients, however, opioid consumption was higher with saline than LB (20.6 MME vs. 13.3 MME, P ¼ .048). Additionally, pre-and postoperative VAS scores and hospital length of stay were not significantly different with either LB or saline.Conclusions: In the setting of PLDF surgery, LB injections did not significantly reduce the consumption of opioids in the first 3 postoperative days, nor did the hospital length of stay or VAS pain scores, compared to saline. However, LB could be beneficial in reducing the consumption of opioids in narcotic-tolerant populations.Level of Evidence: 2.

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“…In a randomized controlled trial evaluating the effect of intraoperative epidural bolus of fentanyl during lumbar decompressive surgery, Guilfoyle et al reported lower early postoperative visual analogue scale (VAS) pain scores within the treated group but also an increased rate of urinary catheterization [49]. In a pair of randomized controlled trials, intrathecal morphine and fentanyl were demonstrated to decrease cumulative opioid demand in patients undergoing lumbar spinal surgery [50,51].…”

Section: Neuraxial Blockadementioning

confidence: 98%

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

Devin

McGirt

2015

Journal of Clinical Neuroscience

203

133

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Therapeutic Effect of Intrathecal Morphine After Posterior Lumbar Interbody Fusion Surgery

Cited by 55 publications

References 33 publications

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

The Efficacy of Liposomal Bupivacaine in Lumbar Spine Surgery

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

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