Comparison of Perioperative Oral Multimodal Analgesia Versus IV PCA for Spine Surgery

@article{Rajpal2010ComparisonOP,
  title={Comparison of Perioperative Oral Multimodal Analgesia Versus IV PCA for Spine Surgery},
  author={Sharad Rajpal and Debra B. Gordon and Teresa A. Pellino and Andrea L Strayer and Denise Brost and Gregory R. Trost and Thomas A. Zdeblick and Daniel K Resnick},
  journal={Journal of Spinal Disorders \& Techniques},
  year={2010},
  volume={23},
  pages={139-145}
}
Study Design A preintervention and postintervention design was used to examine a total of 200 patients. Objective After successful implementation at our institution of a perioperative oral multimodal analgesia protocol in major joint arthroplasty, a modified regimen was provided to patients undergoing spine procedures. Summary of Background Data A proactive, multimodal approach is currently recommended for the management of acute postoperative pain. Inadequate postoperative analgesia can… 
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66 Citations
Background Citations
13
Methods Citations
2

66 Citations

Citation Type

Citation Type

Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion
TLDR
It is suggested that MMA results in lower narcotic consumption than PCA after an anterior cervical discectomy and fusion (ACDF) and is associated with a shorter inpatient stay and a decrease in postoperative nausea/vomiting.
The Impact of Preventative Multimodal Analgesia on Postoperative Opioid Requirement and Pain Control in Patients Undergoing Lumbar Fusions
TLDR
PMA is a highly effective and safe method for postoperative pain management in patients undergoing elective lumbar fusion surgeries by improving pain control and reducing opioid requirement.
Multimodal Pain Management Protocol Versus Patient Controlled Narcotic Analgesia for Postoperative Pain Control after Shoulder Arthroplasty.
TLDR
Those treated with the TLC protocol had greater narcotic utilization but better VAS pain scores at 24 hours after surgery, and both groups experienced rebound pain.
Enhanced recovery after elective spinal and peripheral nerve surgery: pilot study from a single institution.
TLDR
Implementation of this novel ERAS pathway safely reduces patients' postoperative opioid requirements during hospitalization and 1 month postoperatively, and results in improved postoperative mobilization and ambulation.
Multimodal Analgesia Versus Intravenous Patient-Controlled Analgesia for Minimally Invasive Transforaminal Lumbar Interbody Fusion Procedures
TLDR
It is suggested that MMA results in reduced inpatient hospital narcotic consumption compared with PCA after minimally invasive transforaminal lumbar interbody fusion, and resulted in similar analgesia for patients during the inpatient stay.
Multimodal Analgesia Therapy Reduces Length of Hospitalization in Patients Undergoing Fusions of the Ankle and Hindfoot
TLDR
This study provides the first evidence that multimodal therapy reduces the length of stay for patients undergoing major hindfoot or ankle fusion surgery, regardless of surgical complexity.
Implementation of a Standardized Multimodal Postoperative Analgesia Protocol Improves Pain Control, Reduces Opioid Consumption, and Shortens Length of Hospital Stay After Posterior Lumbar Spinal Fusion.
TLDR
Implementation of an evidence-based, multimodal analgesia protocol improved postoperative outcomes, including pain scores, opioid consumption, and length of hospital stay, after posterior lumbar spinal fusion.
The Role of Multimodal Analgesia in Spine Surgery.
TLDR
Because a substantial number of spine surgeries are performed annually, a standardized approach to multimodal analgesia may provide considerable benefits, particularly in the context of the increased emphasis on accountability within the healthcare system.
Multimodal Analgesia (MMA) Versus Patient-Controlled Analgesia (PCA) for One or Two-Level Posterior Lumbar Fusion Surgery
TLDR
The MMA seems to be a good alternative to the PCA after one or two-level PLF, and clinical characteristics, pain score, additional opioid and non-opioid consumption, side effects, and patient subjective satisfaction score were similar between the two groups.
Post-operative Pain Management in Spine Surgery
TLDR
Following spine surgery, the majority of patients report moderate to severe pain that lasts at least 3–4 days affecting recovery and discharge from the hospital and treatment is challenging in these patients because many are not narcotic naive.
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References

SHOWING 1-10 OF 34 REFERENCES
Satisfaction with epidural and intravenous patient-controlled analgesia.
TLDR
Both techniques, i.v. and epidural PCA, result in high levels of satisfaction and maintaining the initial treatment plan can be accurately predicted based on age and preoperative attitudes.
Prospective analysis of a novel long-acting oral opioid analgesic regimen for pain control after total hip and knee arthroplasty.
Multimodal strategies to improve surgical outcome.
A Randomized Trial of Controlled-Release Oxycodone During Inpatient Rehabilitation Following Unilateral Total Knee Arthroplasty
TLDR
Preemptive use of controlled-release oxycodone during rehabilitation following total knee arthroplasty leads to improved pain control, more rapid functional recovery, and a reduced need for inpatient rehabilitative services.
Postoperative patient-controlled analgesia: meta-analyses of initial randomized control trials.
Evaluation of the Optimal Preemptive Dose of Gabapentin for Postoperative Pain Relief After Lumbar Diskectomy: A Randomized, Double-Blind, Placebo-Controlled Study
TLDR
Gabapentin 600 mg is the optimal dose for postoperative pain relief following lumbar diskectomy and its effect on fentanyl consumption during the initial 24 hours in a randomized, double-blinded, placebo-controlled study in 100 patients with American Society of Anesthesiologists physical status I and II.
Do Surgical Patients Benefit from Perioperative Gabapentin/Pregabalin? A Systematic Review of Efficacy and Safety
TLDR
Gabapentinoids effectively reduce postoperative pain, opioid consumption, and opioid-related adverse effects after surgery, and conclusions about the optimal dose and duration cannot be made because of the heterogeneity of the trials.
Systematic Literature Review of the Economics of Intravenous Patient-Controlled Analgesia
TLDR
The advent of several new alternatives in the management of postoperative pain warrants an updated examination of the costs of this modality, and direct medical and nonmedical costs and intangible costs (pain and suffering) from morbidity and mortality were considered.
Analgesic Effects of Gabapentin after Spinal Surgery
TLDR
Preoperative oral gabapentin decreased pain scores in the early postoperative period and postoperative morphine consumption in spinal surgery patients while decreasing some morphine-associated side effects.
The Effects of Postoperative Pain Management on Immune Response to Surgery
TLDR
Patients receiving an epidural mixture of opiate and local anesthetics (PCEA group) exhibited reduced suppression of lymphocyte proliferation and attenuated proinflammatory cytokine response in the postoperative period.
...
1
2
3
4
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