title: The Role of Multimodal Analgesia in Spine Surgery.
abstract: Optimal postoperative pain control allows for faster recovery, reduced complications, and improved patient satisfaction. Historically, pain management after spine surgery relied heavily on opioid medications. Multimodal regimens were developed to reduce opioid consumption and associated adverse effects. Multimodal approaches used in orthopaedic surgery of the lower extremity, especially joint arthroplasty, have been well described and studies have shown reduced opioid consumption, improved pain and function, and decreased length of stay. A growing body of evidence supports multimodal analgesia in spine surgery. Methods include the use of preemptive analgesia, NSAIDs, the neuromodulatory agents gabapentin and pregabalin, acetaminophen, and extended-action local anesthesia. The development of a standard approach to multimodal analgesia in spine surgery requires extensive assessment of the literature. Because a substantial number of spine surgeries are performed annually, a standardized approach to multimodal analgesia may provide considerable benefits, particularly in the context of the increased emphasis on accountability within the healthcare system.
authors.affiliation: From the Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA (Dr. Kreitz), and the Rothman Institute, Philadelphia, PA (Dr. Kurd, Dr. Schroeder, and Dr. Vaccaro).
authors.forename: Mark F
authors.initials: MF
authors.lastname: Kurd
authors.forename: Tyler
authors.initials: T
authors.lastname: Kreitz
authors.forename: Gregory
authors.initials: G
authors.lastname: Schroeder
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000588:Amines / Q000008:administration & dosage; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D004333:Drug Administration Routes; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D000069583:Pregabalin / Q000008:administration & dosage; D013131:Spine / Q000601:surgery*; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
chemical_list: D000588:Amines; D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal; D003509:Cyclohexanecarboxylic Acids; D000082:Acetaminophen; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin