title: A multimodal approach for postoperative pain management after lumbar decompression surgery: a prospective, randomized study.
abstract: METHODS
  A prospective and randomized study.
  
  
  OBJECTIVE
  The objective of this study was to assess the efficacy of a novel multimodal analgesic regimen in reducing postoperative pain and intravenous morphine requirements after primary multilevel lumbar decompression surgery.
  
  
  BACKGROUND
  The use of opioid medications after surgery can lead to incomplete analgesia and may cause undesired side effects such as respiratory depression, somnolence, urinary retention, and nausea. Multimodal (opioid and nonopioid combination) analgesia may be an effective alternative to morphine administration leading to improved postoperative analgesia with diminished side effects.
  
  
  METHODS
  After Institutional Review Board approval, 22 patients who underwent a primary multilevel lumbar decompression procedure were randomly assigned to receive either only intravenous morphine or a multimodal (celecoxib, pregabalin, extended release oxycodone) analgesic regimen. Postoperatively, all patients were allowed to receive intravenous morphine on an as needed basis. Intravenous morphine requirements were then recorded immediately postoperative, at 6, 12, 24 hours, and the total requirement before discharge. Patient postoperative pain levels were determined using the visual analog pain scale and were documented at 0, 4, 8, 12, 16, 24, and 36 hours postoperative.
  
  
  RESULTS
  There were no significant differences in available patient demographics, intraoperative blood loss, or postoperative hemovac drain output between study groups. Total postoperative intravenous morphine requirements in addition to morphine requirements at all predetermined time points were less in patients randomized to receive the multimodal analgesic regimen. Visual analog pain scores were lower at all postoperative time points in patients randomized to receive the multimodal analgesic regimen. Time to solid food was significantly less in the multimodal group. There were no major identifiable postoperative complications in either treatment group.
  
  
  CONCLUSIONS
  Opioid and nonopioid analgesic combinations appear to be safe and effective after lumbar laminectomy. Patients demonstrate lower intravenous morphine requirements, better pain scores, and earlier time to solid food intake.
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA. ryangarcia78@gmail.com
authors.forename: Ryan Michael
authors.initials: RM
authors.lastname: Garcia
authors.forename: Ezequiel H
authors.initials: EH
authors.lastname: Cassinelli
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Messerschmitt
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Furey
authors.forename: Henry H
authors.initials: HH
authors.lastname: Bohlman
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000700:Analgesics / Q000008:administration & dosage / Q000627:therapeutic use*; D000068579:Celecoxib; D019299:Decompression, Surgical / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000069583:Pregabalin; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use*; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000700:Analgesics; D011720:Pyrazoles; D013449:Sulfonamides; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D009020:Morphine; D010098:Oxycodone; D000068579:Celecoxib