PT  - JOURNAL ARTICLE
AU  - Markowitz, Michael
AU  - Woods, Barrett
AU  - Schroeder, Gregory
AU  - Kepler, Christopher
AU  - Kaye, David
AU  - Kurd, Mark
AU  - Armstrong, Joshua
AU  - Vaccaro, Alexander
AU  - Radcliff, Kris
TI  - A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study
AID  - 10.14444/8484
DP  - 2023 Dec 01
TA  - International Journal of Spine Surgery
PG  - 828--834
VI  - 17
IP  - 6
4099  - https://www.ijssurgery.com/content/17/6/828.short
4100  - https://www.ijssurgery.com/content/17/6/828.full
SO  - Int J Spine Surg2023 Dec 01; 17
AB  - Background There has been increased interest in exploring methods to reduce postoperative pain without opioid medications. In 2015, a multimodal analgesia protocol was used involving the perioperative use of celecoxib, gabapentin, intravenous acetaminophen, lidocaine, and liposomal bupivacaine. Overall, the goal was to reduce the utilization of scheduled opioids in favor of nonopioid pain management.Methods The results of a consecutive series of 1- to 2-level open primary lumbar fusions were compared to a cohort of patients after the implementation the perioperative multimodal pain management protocol. Primary endpoints included patient-reported pain scores and secondary endpoints included length of stay.Results There were 87 patients in the preprotocol cohort and 184 in the protocol cohort. Comparing protocol and preprotocol patients, there were no significant differences in patient demographics. There was significantly average lower pain in the protocol group on postoperative day (POD) 1 (4.50 vs 5.00, P < 0.02) and POD2 (4.42 vs 5.50, P < 0.03). There was a lower pain score on POD0 (4.80 vs 5.00), but it was only clinically significant. There was a correlation between pain and duration of surgery in the preprotocol patients (POD0 R = 0.23, POD1 R = 0.02, POD2 R = 0.38), but not in the protocol patients (POD0 R = −0.05, POD1 R = −0.08, POD2 R = −0.04). There was a shorter length of stay in the protocol cohort (2.0 vs 3.0, P < 0.01). Finally, there was an approximately 35% reduction in morphine milligram equivalents of opioids in the protocol vs preprotocol cohorts (36.2 vs 57.0, P < 0.05).Conclusion Our novel multimodal pain management protocol significantly reduced postoperative pain, length of stay, and opioid consumption in this patient cohort. Opioid usage correlated to pain in the protocol patients, while the preprotocol patients had no correlation between opioid use and pain medication.Clinical Relevance In this study, we demonstrated that preoperative and intraoperative analgesia can reduce postoperative pain medication requirements. Furthermore, we introduced a novel concept of a correlation of pain with opioid consumption as a marker of effective pain management of breakthrough pain.Level of Evidence 4.