Multimodal Analgesic Regimen for Spine Surgery: A Randomized Placebo-controlled Trial

Area of Science:

• Anesthesiology
• Neurosurgery
• Pain Management

Background:

• Multimodal analgesic strategies are crucial for managing postoperative pain in spine surgery.
• Evaluating non-opioid analgesics offers potential for improved patient outcomes and reduced opioid dependence.

Purpose of the Study:

• To assess the efficacy of a specific multimodal analgesic regimen in enhancing recovery after spine surgery.
• To compare postoperative pain, opioid consumption, and quality of recovery between the analgesic pathway and placebo groups.

Main Methods:

• A double-blind, randomized trial involving high-risk adult patients undergoing multilevel spine surgery.
• The intervention group received acetaminophen, gabapentin, ketamine, and lidocaine; the control group received a placebo.
• Outcomes included the Quality of Recovery 15-questionnaire, 48-hour opioid consumption, and pain scores.

Main Results:

• The trial was terminated early due to futility, showing no significant difference in Quality of Recovery scores between groups (mean difference 0, P=0.920).
• No significant improvement was observed in 48-hour opioid consumption (median difference -9 mg, P=0.175) or pain scores (mean difference -0.4, P=0.094) in the analgesic pathway group.
• The multimodal approach did not demonstrate superiority over placebo in key recovery and pain management metrics.

Conclusions:

• The studied analgesic pathway did not improve recovery in patients undergoing multilevel spine surgery.
• This combination of non-opioid analgesics, including acetaminophen, gabapentin, ketamine, and lidocaine, was not effective in reducing postoperative pain or opioid use compared to placebo.