title: Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion.
abstract: METHODS
  Retrospective analysis of a prospectively maintained surgical registry.
  
  
  OBJECTIVE
  To compare postoperative narcotic consumption between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) after an anterior cervical discectomy and fusion (ACDF).
  
  
  BACKGROUND
  Studies suggest that a multimodal approach to pain management leads to decreased pain and morphine consumption after total joint arthroplasty and lumbar spinal procedures. Patients and surgeons would benefit from knowing whether a multimodal approach to pain management is superior to PCA for ACDF.
  
  
  METHODS
  A retrospective cohort study of ACDF patients receiving either MMA or PCA was conducted. Inpatient narcotic consumption, pain scores, nausea/vomiting, hospital length of stay, and narcotic dependence during the months after surgery were compared between MMA and PCA.
  
  
  RESULTS
  A total of 239 patients met inclusion criteria. Of these, 55 (23.0%) received MMA and 184 (77.0%) received PCA. Patients who received MMA had a lower rate of inpatient narcotic consumption (2.5 OME/h vs. 5.8 OME/h, P < 0.001) were less likely to experience nausea/vomiting during the hospitalization (5.5% vs. 37.5%, P < 0.001), and had a shorter hospital length of stay (27.3 vs. 40.1 h, P < 0.001). However, there was no difference between groups in mean visual analogue pain scale during postoperative day zero (4.7 for MMA vs. 5.2 for PCA, P = 0.126) or during postoperative day one (4.1 for MMA vs. 4.1 for PCA, P = 0.937). In addition, there was no difference in the rate of narcotic dependence at the first (P = 0.626) or second (P = 0.480) postoperative visits.
  
  
  CONCLUSIONS
  These data suggest that MMA results in lower narcotic consumption than PCA after an ACDF. This difference is associated with a shorter inpatient stay and a decrease in postoperative nausea/vomiting. Critically, MMA and PCA appear to provide similar postoperative analgesia.
  
  
  METHODS
  3.
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Philip K
authors.initials: PK
authors.lastname: Louie
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Neal
authors.initials: N
authors.lastname: Shah
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Mayo
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Tae D
authors.initials: TD
authors.lastname: Kim
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Dustin H
authors.initials: DH
authors.lastname: Massel
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Krishna D
authors.initials: KD
authors.lastname: Modi
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: William W
authors.initials: WW
authors.lastname: Long
authors.affiliation: Anesthesiology and Pain Medicine, Rush University Medical Center, Chicago, IL.
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
authors.affiliation: Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled / Q000379:methods* / Q000592:standards; D000701:Analgesics, Opioid / Q000008:administration & dosage; D002574:Cervical Vertebrae / Q000601:surgery*; D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D019299:Decompression, Surgical / Q000009:adverse effects*; D017586:Diskectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000379:methods* / Q000592:standards; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*
chemical_list: D000701:Analgesics, Opioid