Twin Cities Spine Center, Minneapolis, MN (Ramirez-Gonzalez), University of Puerto Rico School of Medicine, University of Puerto Rico Medical Sciences Campus, San Juan, PR (Claudio-Roman), Department of Orthopaedic Surgery, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Deliz-Jimenez, Torres-Lugo, and Echegaray-Casalduc, Massanet-Volrath, Carro-Rivera, Escobar-Medina, De La Cruz, and Montañez-Huertas), Department of Pediatric Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, PR (Ramirez), Department of Anesthesiology, University of Puerto Rico, Medical Sciences Campus, San Juan, PR (Colon-Rodriguez).
J Am Acad Orthop Surg. 2023 Sep 1;31(17):931-937. doi: 10.5435/JAAOS-D-22-00878. Epub 2023 May 15.
Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative pain control for spine surgery has relied on opioids. However, opioid use is associated with adverse effects such as dependence, respiratory depression, and altered cognition. Our study aimed to determine whether an opioid-sparing multimodal analgesia regimen (ketorolac, orphenadrine, and gabapentin) could be a viable alternative to diminish opioid use compared with a standard opioid-based regimen in Hispanic patients undergoing posterior lumbar spinal fusion.
This was a randomized controlled trial of Hispanic patients scheduled to undergo elective posterior spinal fusion. Inclusion criteria included age 30 to 85 years, Hispanic ethnicity, lumbar stenosis between L1 and S1, elective posterior spinal fusion with instrumentation, American Society of Anesthesiologists Score <2, and consent to participate in the study. Patients were randomized into two groups, an experimental multimodal analgesia and control (opioid-based) treatment groups, and outcomes such as morphine milligram equivalents used, visual analog scale score, and length of hospital stay were compared between the groups.
The MMA experimental group used significantly lower amounts of opioid (measured with morphine milligram equivalent) than the opioid-based group during the 12-hour and 24-hour postoperative periods ( P -value = 0.023 and P -value = 0.033, respectively). No statistically significant difference was observed in opioid use in the 48-hour postoperative period between both groups ( P -value = 0.066). The MMA group had significantly lower VAS scores reported at the 12-hour, 24-hour, and 48-hour postoperative periods compared with the opioid-based group ( P -values = 0.016, 0.020, and 0.020, respectively). No difference was observed in the length of hospital stay between groups ( P -value = 0.169).
Implementing an MMA protocol in Hispanic patients undergoing posterior lumbar fusion resulted in decreased overall opioid use and decreased pain intensity compared with the opioid-based group. MMA is an effective alternative for pain control in patients who want to avoid opioid use.
Identifier: NCT05413902.
随着人口老龄化，后路腰椎融合术变得越来越普遍，退行性疾病是最常见的适应证。历史上，脊柱手术的术后疼痛控制依赖于阿片类药物。然而，阿片类药物的使用与依赖、呼吸抑制和认知改变等不良反应有关。我们的研究旨在确定与基于阿片类药物的标准方案相比，使用酮咯酸、奥芬那君和加巴喷丁的阿片类药物节约型多模式镇痛方案是否可以作为减少 Hispanic 患者后路腰椎融合术后阿片类药物使用的可行替代方案。
这是一项针对计划接受择期后路脊柱融合术的 Hispanic 患者的随机对照试验。纳入标准包括年龄 30 至 85 岁、 Hispanic 族裔、L1 至 S1 之间的腰椎狭窄症、择期后路脊柱融合伴内固定、美国麻醉医师协会评分<2 分、并同意参与研究。患者被随机分为两组，实验组采用多模式镇痛，对照组（基于阿片类药物的）治疗，比较两组之间吗啡用量、视觉模拟评分和住院时间等结果。
实验组在术后 12 小时和 24 小时期间使用的阿片类药物（以吗啡毫克当量衡量）明显低于对照组（P 值分别为 0.023 和 0.033）。两组在术后 48 小时期间的阿片类药物使用量无统计学差异（P 值为 0.066）。实验组在术后 12 小时、24 小时和 48 小时的 VAS 评分明显低于对照组（P 值分别为 0.016、0.020 和 0.020）。两组的住院时间无差异（P 值为 0.169）。
在接受后路腰椎融合术的 Hispanic 患者中实施多模式镇痛方案可减少总体阿片类药物使用量和疼痛强度，与基于阿片类药物的方案相比。MMA 是希望避免使用阿片类药物的患者控制疼痛的有效替代方案。
标识符：NCT05413902。
