A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study

Area of Science:

• Orthopedic Surgery
• Pain Management
• Anesthesiology

Background:

• Growing interest in non-opioid pain management strategies to reduce postoperative pain.
• Implementation of a multimodal analgesia protocol in 2015, including celecoxib, gabapentin, IV acetaminophen, lidocaine, and liposomal bupivacaine.
• Objective to minimize scheduled opioid use in favor of non-opioid pain relief.

Purpose of the Study:

• To evaluate the effectiveness of a perioperative multimodal pain management protocol.
• To compare postoperative pain scores and length of stay between patients receiving the protocol and those who did not.
• To assess the impact of the protocol on opioid consumption.

Main Methods:

• Retrospective comparison of patients undergoing 1- to 2-level open primary lumbar fusions.
• Analysis of data from a pre-protocol cohort (n=87) and a post-protocol cohort (n=184).
• Primary endpoints: patient-reported pain scores; Secondary endpoints: length of stay.

Main Results:

• The protocol group showed significantly lower average pain scores on postoperative days 1 and 2 (P < 0.02, P < 0.03).
• A shorter length of stay was observed in the protocol cohort (2.0 vs 3.0 days, P < 0.01).
• A 35% reduction in opioid consumption (morphine milligram equivalents) was noted in the protocol group (36.2 vs 57.0, P < 0.05).

Conclusions:

• The novel multimodal pain management protocol effectively reduced postoperative pain, length of stay, and opioid consumption.
• A significant correlation between pain and opioid use was absent in the protocol group, unlike the pre-protocol group.
• Preoperative and intraoperative analgesia can decrease postoperative pain medication requirements and serve as a marker for effective pain management.