Multimodal Analgesia Versus Intravenous Patient-Controlled Analgesia for Minimally Invasive Transforaminal Lumbar Interbody Fusion Procedures

作者：Singh Kern^*; Bohl Daniel D; Ahn Junyoung; Massel Dustin H; Mayo Benjamin C; Narain Ankur S; Hijji Fady Y; Louie Philip K; Long William W; Modi Krishna D; Kim Tae D; Kudaravalli Krishna T; Phillips Frank M; Buvanendran Asokumar

来源：Spine, 2017, 42(15): 1145-1150.

DOI：10.1097/BRS.0000000000001992

• degenerative
• inpatient pain
• length of stay
• minimally invasive
• multimodal analgesia
• narcotics consumption
• nausea/vomiting
• patient-controlled analgesia
• transforaminal lumbar interbody fusion
• urinary retention

Study Design. Retrospective analysis.
Objective. To compare postoperative narcotic consumption and pain scores between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
Summary of Background Data. A multimodal analgesic approach to pain management may lead to decreased pain and narcotic consumption after orthopedic procedures. Additional evidence is, however, required to determine how MMA compares to intravenous PCA after MIS TLIF.
Methods. Patients undergoing 1-level MIS TLIF followed by either MMA or PCA at our institution were compared in terms of inpatient pain scores, narcotic consumption, hospital length of stay, rates of surgical complications, rates of inpatient nausea/vomiting, rates of postoperative urinary retention, and rates of narcotic consumption during the months after discharge.
Results. A total of 139 patients met inclusion criteria. Of these, 39 (28.1%) received MMA and 100 (71.9%) received PCA. Demographic and comorbidity characteristics did not differ between cohorts. Compared with patients receiving PCA, patients receiving MMA had a lower rate of inpatient narcotic consumption (2.8 perpendicular to 1.9 vs. 5.3 perpendicular to 4.4 oral morphine equivalents/hour, P < 0.001), a lower rate of inpatient nausea/vomiting (20.5% vs. 48.0%; P = 0.003), and a shorter hospital length of stay (53.0 +/- 25.3 vs. 62.6 +/- 24.4 h, P = 0.041). There were no differences in Numeric Rating Scale pain score between cohorts for day 0, postoperative day 1, or postoperative day 2 (P > 0.05 for each). There was no difference in the rate of postoperative urinary retention (P > 0.05). Similarly, there were no differences in narcotic consumption at 6 or 12 weeks postoperatively (P > 0.05 for each).
Conclusion. These findings suggest that MMA results in reduced inpatient hospital narcotic consumption compared with PCA after MIS TLIF. The decrease in narcotic consumption may contribute to the observed decrease in the rate of inpatient nausea/vomiting and shorter hospital length of stay. Importantly, MMA and PCA resulted in similar analgesia for patients during the inpatient stay.

• 出版日期2017-8-1