European Spine Journal

, Volume 22, Issue 9, pp 2089–2096 | Cite as

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

  • Ole MathiesenEmail author
  • Benny Dahl
  • Berit A. Thomsen
  • Birgitte Kitter
  • Nan Sonne
  • Jørgen B. Dahl
  • Henrik Kehlet
Original Article



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.


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.


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.


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.


Major spine surgery Multimodal pain treatment Opioid consumption Mobilization 


Conflict of interest

Benny Dahl is funded by a grant from the Danish Strategic Research Council (#2142-08-0017). No other funding was received for the study.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Ole Mathiesen
    • 1
    Email author
  • Benny Dahl
    • 2
  • Berit A. Thomsen
    • 1
  • Birgitte Kitter
    • 1
  • Nan Sonne
    • 1
  • Jørgen B. Dahl
    • 3
  • Henrik Kehlet
    • 4
  1. 1.Section of Acute Pain Management and Palliative Medicine, Department of Anesthesia 4231Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University HospitalCopenhagen ØDenmark
  2. 2.Spine Unit, Department of Orthopaedic Surgery 3191Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
  3. 3.Department of Anesthesia 4231Rigshospitalet, Copenhagen University HospitalCopenhagenDenmark
  4. 4.Section for Surgical PathophysiologyRigshospitalet, Copenhagen University HospitalCopenhagenDenmark

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