title: A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Section of Acute Pain Management and Palliative Medicine, Department of Anesthesia 4231, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark, olemat@dadlnet.dk.
authors.forename: Ole
authors.initials: O
authors.lastname: Mathiesen
authors.forename: Benny
authors.initials: B
authors.lastname: Dahl
authors.forename: Berit A
authors.initials: BA
authors.lastname: Thomsen
authors.forename: Birgitte
authors.initials: B
authors.lastname: Kitter
authors.forename: Nan
authors.initials: N
authors.lastname: Sonne
authors.forename: Jørgen B
authors.initials: JB
authors.lastname: Dahl
authors.forename: Henrik
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage / Q000009:adverse effects; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000588:Amines / Q000008:administration & dosage / Q000009:adverse effects; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage* / Q000009:adverse effects; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects; D016022:Case-Control Studies; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage / Q000009:adverse effects; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects; D004359:Drug Therapy, Combination; D005260:Female; D000077206:Gabapentin; D006801:Humans; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced / Q000188:drug therapy; D013122:Spinal Diseases / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects*; D055815:Young Adult; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000009:adverse effects
chemical_list: D000588:Amines; D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000932:Antiemetics; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D003907:Dexamethasone