Document Detail


A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery.
MedLine Citation:
PMID:  23681498     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Ole Mathiesen; Benny Dahl; Berit A Thomsen; Birgitte Kitter; Nan Sonne; Jørgen B Dahl; Henrik Kehlet
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Publication Detail:
Type:  Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2013-05-17
Journal Detail:
Title:  European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society     Volume:  22     ISSN:  1432-0932     ISO Abbreviation:  Eur Spine J     Publication Date:  2013 Sep 
Date Detail:
Created Date:  2013-09-19     Completed Date:  2014-04-28     Revised Date:  2014-09-02    
Medline Journal Info:
Nlm Unique ID:  9301980     Medline TA:  Eur Spine J     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  2089-96     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Acetaminophen / administration & dosage,  adverse effects
Adolescent
Adult
Aged
Aged, 80 and over
Amines / administration & dosage,  adverse effects
Analgesics, Non-Narcotic / administration & dosage*,  adverse effects
Analgesics, Opioid / administration & dosage*,  adverse effects
Antiemetics / administration & dosage,  adverse effects
Case-Control Studies
Cyclohexanecarboxylic Acids / administration & dosage,  adverse effects
Dexamethasone / administration & dosage,  adverse effects
Drug Therapy, Combination
Female
Humans
Male
Middle Aged
Pain, Postoperative / drug therapy*
Postoperative Nausea and Vomiting / chemically induced,  drug therapy
Spinal Diseases / surgery*
Spinal Fusion / adverse effects*
Young Adult
gamma-Aminobutyric Acid / administration & dosage,  adverse effects
Chemical
Reg. No./Substance:
0/Amines; 0/Analgesics, Non-Narcotic; 0/Analgesics, Opioid; 0/Antiemetics; 0/Cyclohexanecarboxylic Acids; 362O9ITL9D/Acetaminophen; 56-12-2/gamma-Aminobutyric Acid; 6CW7F3G59X/gabapentin; 7S5I7G3JQL/Dexamethasone
Comments/Corrections

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