Lightning Podiums: Value and Outcomes in Spinal Surgery - Room 801B

Presented by: M. Cabanne

Author(s):

M. Cabanne(1), M. Kardile(1), K. Majid(1), C. Kuo(1), M. Gjolaj(2), R. Bains(1)

(1) Kaiser Permanente, Regional Spine Surgery Department, Oakland, CA, United States
(2) Kaiser Permanente, Dept of Anesthesia, Oakland, CA, United States

Abstract

Background: Post-operative pain control has been directly related to earlier mobilization, decreased length of stay, decreased side effects from narcotic medications, improved patient satisfaction and decreased risk of developing chronic pain. Purpose of this study was to evaluate the efficacy of Multimodal Anesthesia (MMA) pathway in patients undergoing one- or two-level anterior lumbar interbody fusions with posterior percutaneous pedicle screw fixation

Methods: Consecutive patients undergoing one- or two-level anterior lumbar interbody fusions with posterior percutaneous pedicle screw fixation were studied before (24 patients) and after (24 patients) the use of an institution wide multimodal anesthesia pathway. The pathway included pre- and post- operative IV acetaminophen and pregabalin along with intra- operative ketamine and lidocaine infusions and single-dose IV methadone. These groups were compared in terms of pre-operative narcotic use (milligram morphine equivalent = MME) postoperative pain scores at regular intervals (0, 8, 16, 24, 48, 72, 96 hours), narcotic use in perioperative period, at discharge and at 6 weeks follow up, length of stay, and 30 day ER visits.

Results: Multimodal Anesthesia was associated with a significant decrease in early post-operative pain scores within 24 hours (p < 0.002), decreased length of stay (3.38 days vs 4.04 days, P < 0.05), however, there was no significant difference in pain score after 24 hours. The intra-operative use of opioids is higher in the MMA group in the peri-operative period as compared to the Non-MMA group (p 0.002). The MMA group has also a higher incidence of 30 day return to the ER for various reasons as compared to the non-MMA group. There was no significant difference in opioid usage between the two groups at 6 weeks follow up.

Conclusion: Our institutional multimodal anesthesia pathway was an effective tool to decrease early post-operative pain scores and length of stay. MMA was not beneficial in controlling post-operative pain after 24 hours. MMA was also associated with increased opioid usage in the peri-operative period and with increased return to ER within 30 days of surgery. There is was no difference in opioid use between the two groups at 6 weeks follow up.