Multimodal versus Patient-Controlled Analgesia following Transforaminal Lumbar Interbody Fusion

Presented at SMISS Annual Forum 2016
By Kern Singh MD
With

Disclosures: Kern Singh MD B; Depuy, Zimmer, Stryker. D; Avaz Surgical, LLC, Vital 5, LLC. F; Zimmer, Stryker, Pioneer, Lippincott Williams & Wilkins, Thieme, Jaypee Publishing, Slack Publishing.

Introduction

There has been increasing use of multimodal analgesia (MMA) following spinal procedures.

Aims/Objectives

To compare postoperative narcotic consumption between patients receiving MMA and patients receiving patient-controlled analgesia (PCA) following a minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF). 

Methods

A retrospective cohort study was conducted. Patients undergoing MIS TLIF for degenerative spondylolisthesis were identified. Patients were categorized as having received either MMA (more recently treated patients) or PCA (historic controls). Total inpatient narcotic consumption in oral morphine equivalent (OME) was calculated for each patient. This value was divided by the hospital length of stay to calculate the average rate of narcotic consumption over the inpatient stay (in OME/hour). Narcotic dependence at the first and second postoperative visits was determined based on filling of narcotic prescriptions during the weeks following each of these visits. The rates of inpatient narcotic consumption and narcotic dependence at the first and second postoperative visits were compared between patients who received MMA and patients who received PCA. 

Results

A total of 139 patients met inclusion criteria. Of these, 39 (28.1%) received MMA and 100 (71.9%) received PCA. Baseline characteristics were not statistically different between groups. Patients who received MMA had a lower rate of inpatient narcotic consumption than patients who received PCA (2.8 OME/hour versus 5.3 OME/hour, p<0.001). Patients who received PCA were more likely to have nausea/vomiting during the inpatient stay than patients who received MMA (48.0% versus 20.5%, p=0.003). There was no difference in the rate of narcotic dependence at the first postoperative visit between patients who received MMA and patients who received PCA (50.0% versus 33.7%, p=0.079). Similarly, there was no difference in the rate of narcotic dependence at the second postoperative visit between patients who received MMA and patients who received PCA (66.7% versus 51.0%, p=0.095). 

Conclusions

These data suggest that patients undergoing MIS TLIF may have lower narcotic consumption during the inpatient stay with use of MMA than with use of PCA. This results in a decrease in the number of episodes of nausea/vomiting during the inpatient stay. However, this difference does not appear to result in a difference in the risk for narcotic dependence during the months following surgery.