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



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.



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.



The preemptive multimodal analgesic combination in this study appears to be safe and effective after lumbar fusion surgery.
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Sang-Il
SI
Kim
Department of Orthopaedic Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Kee-Yong
KY
Ha
Department of Orthopaedic Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea. insoooh@catholic.ac.kr.
In-Soo
IS
Oh
D000082:Acetaminophen / Q000627:therapeutic use; D000368:Aged; D000700:Analgesics / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000068579:Celecoxib / Q000627:therapeutic use; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010149:Postoperative Pain / Q000517:prevention & control*; D000069583:Pregabalin / Q000627:therapeutic use; D011446:Prospective Studies; D013123:Spinal Fusion; D064232:Visual Analog Scale
D000700:Analgesics; D000701:Analgesics, Opioid; D003692:Delayed-Action Preparations; D000082:Acetaminophen; D000069583:Pregabalin; D009020:Morphine; D000068579:Celecoxib
Analgesia; Multimodal; Postoperative pain; Preemptive; Spinal fusion