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Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial

European Spine Journal volume 25, pages 1614–1619 (2016)Cite this article

Abstract

Purpose

To assess the efficacy of a novel preemptive multimodal analgesic regimen for reducing postoperative pain and complications after primary lumbar fusion surgery. Preemptive multimodal analgesia is revealed to be an effective alternative to conventional morphine administration providing improved postoperative pain control with diminished side effects. However, an optimal regimen for spinal fusion surgery remains unknown.

Methods

After Institutional Review Board approval, 80 patients who underwent primary lumbar 4–5 fusion surgery were randomly assigned to receive either only intravenous morphine or a preemptive multimodal (celecoxib, pregabalin, extended-release oxycodone, and acetaminophen) analgesic regimen. Postoperative pain and functional levels were measured by the visual analog scale (VAS) and Oswestry Disability Index (ODI), respectively, and intraoperative blood loss, postoperative Hemovac drain output, and nonunion rates were evaluated for complications.

Results

No differences were observed in the patient demographics, intraoperative blood loss, postoperative Hemovac drain output, or nonunion rate between two groups. The VAS and ODI were lower at all postoperative time points, except the ODI on postoperative day 1 in patients randomized to receive the preemptive multimodal analgesic regimen. No major identifiable postoperative complications were observed in either treatment group.

Conclusions

The preemptive multimodal analgesic combination in this study appears to be safe and effective after lumbar fusion surgery.

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Author information

Affiliations

  1. Department of Orthopaedic Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

    Sang-Il Kim & Kee-Yong Ha

  2. Department of Orthopaedic Surgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    In-Soo Oh

Authors
  1. Sang-Il Kim
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  2. Kee-Yong Ha
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  3. In-Soo Oh
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Corresponding author

Correspondence to In-Soo Oh.

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Conflict of interest

The authors declare that they have no conflict of interest including pharmaceutical company involvement. No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Kim, SI., Ha, KY. & Oh, IS. Preemptive multimodal analgesia for postoperative pain management after lumbar fusion surgery: a randomized controlled trial. Eur Spine J 25, 1614–1619 (2016). https://doi.org/10.1007/s00586-015-4216-3

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  • DOI: https://doi.org/10.1007/s00586-015-4216-3

Keywords

  • Preemptive
  • Multimodal
  • Analgesia
  • Postoperative pain
  • Spinal fusion