56.
A comprehensive multimodal pain treatment improves postoperative
mobilization after multilevel spine surgery
Ole Mathiesen, Benny Dahl, Berit Thomsen, Birgitte Kitter, Jørgen Dahl,
Henrik Kehlet
Section of Acute Pain Management and Palliative Medicine Rigshospitalet;
Department of Orthopaedic Surgery, Rigshospitalet; Section of Acute Pain
Management and Palliative Medicine , Rigshospitalet; Section of Acute Pain
Management and Palliative Medicine , Rigshospitalet; Department of
Anesthesia , Righsopitalet; Section for Surgical Pathophysiology,
Rigshospitalet
Background:
Major spine surgery with posterior instrumentation is often
followed by significant pain, large amount of opioid consumption and difficult
mobilization. The introduction of a comprehensive pain and postoperative
nausea and vomiting (PONV) treatment protocol in other areas of surgery has
reduced these problems.
Purpose / Aim of Study:
To investigate if a multimodal postoperative pain
and nausea treatment protocol would improve pain treatment and mobilization
following major spine surgery
Materials and Methods:
A new standardized 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
posterior multilevel instrumented spinal fusions and compared with 44 patients
in a pre-intervention group.
Findings / Results:
Compared to the pre-intervention group, patients
following the new treatment protocol were mobilized earlier (P=0.003).
Patients treated according to the new protocol experienced less pain (P=0.03),
consumed less opioid (P=0.02) and had reduced length of stay (P=0.007) in the
postanaesthesia care unit (PACU). Furthermore, they consumed less opioid on
postoperative day (POD) 1 (P=0.024) and 2 (P=0.048) compared to those in
the pre-intervention group. Finally, patients following the new protocol
experienced low intensities of nausea, sedation and dizziness on POD 1 to 6.
Conclusions:
A standardized comprehensive multimodal pain and PONV
protocol significantly improved mobilization and reduced opioid consumption
with concomitant low levels of nausea, sedation and dizziness. Furthermore,
pain scores, morphine consumption and length of stay were reduced at the
PACU.
