title: Multimodal Analgesia Versus Intravenous Patient-Controlled Analgesia for Minimally Invasive Transforaminal Lumbar Interbody Fusion Procedures.
abstract: METHODS
  Retrospective analysis.
  
  
  OBJECTIVE
  To compare postoperative narcotic consumption and pain scores between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) following minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).
  
  
  BACKGROUND
  A multimodal analgesic approach to pain management may lead to decreased pain and narcotic consumption after orthopedic procedures. Additional evidence is, however, required to determine how MMA compares to intravenous PCA after MIS TLIF.
  
  
  METHODS
  Patients undergoing 1-level MIS TLIF followed by either MMA or PCA at our institution were compared in terms of inpatient pain scores, narcotic consumption, hospital length of stay, rates of surgical complications, rates of inpatient nausea/vomiting, rates of postoperative urinary retention, and rates of narcotic consumption during the months after discharge.
  
  
  RESULTS
  A total of 139 patients met inclusion criteria. Of these, 39 (28.1%) received MMA and 100 (71.9%) received PCA. Demographic and comorbidity characteristics did not differ between cohorts. Compared with patients receiving PCA, patients receiving MMA had a lower rate of inpatient narcotic consumption (2.8 ± 1.9 vs. 5.3 ± 4.4 oral morphine equivalents/hour, P < 0.001), a lower rate of inpatient nausea/vomiting (20.5% vs. 48.0%; P = 0.003), and a shorter hospital length of stay (53.0 ± 25.3 vs. 62.6 ± 24.4 h, P = 0.041). There were no differences in Numeric Rating Scale pain score between cohorts for day 0, postoperative day 1, or postoperative day 2 (P > 0.05 for each). There was no difference in the rate of postoperative urinary retention (P > 0.05). Similarly, there were no differences in narcotic consumption at 6 or 12 weeks postoperatively (P > 0.05 for each).
  
  
  CONCLUSIONS
  These findings suggest that MMA results in reduced inpatient hospital narcotic consumption compared with PCA after MIS TLIF. The decrease in narcotic consumption may contribute to the observed decrease in the rate of inpatient nausea/vomiting and shorter hospital length of stay. Importantly, MMA and PCA resulted in similar analgesia for patients during the inpatient stay.
  
  
  METHODS
  4.
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Kern
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Daniel D
authors.initials: DD
authors.lastname: Bohl
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Junyoung
authors.initials: J
authors.lastname: Ahn
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Dustin H
authors.initials: DH
authors.lastname: Massel
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: Mayo
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Ankur S
authors.initials: AS
authors.lastname: Narain
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Fady Y
authors.initials: FY
authors.lastname: Hijji
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Philip K
authors.initials: PK
authors.lastname: Louie
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: William W
authors.initials: WW
authors.lastname: Long
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Krishna D
authors.initials: KD
authors.lastname: Modi
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Tae D
authors.initials: TD
authors.lastname: Kim
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Krishna T
authors.initials: KT
authors.lastname: Kudaravalli
authors.affiliation: Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Phillips
authors.affiliation: Department of Anesthesiology, Rush University Medical Center, Chicago, IL.
authors.forename: Asokumar
authors.initials: A
authors.lastname: Buvanendran
mesh_terms: D000368:Aged; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000639:trends; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000175:diagnosis / Q000517:prevention & control*; D011446:Prospective Studies; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects* / Q000639:trends