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The Role of Multimodal Analgesia in Spine Surgery

Kurd, Mark F. MD; Kreitz, Tyler MD; Schroeder, Gregory MD; Vaccaro, Alexander R. MD, PhD, MBA

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: April 2017 - Volume 25 - Issue 4 - p 260–268
doi: 10.5435/JAAOS-D-16-00049
Review Article

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.

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).

Dr. Kurd or an immediate family member serves as a paid consultant to Stryker. Dr. Schroeder or an immediate family member has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from Medtronic. Dr. Vaccaro or an immediate family member has received royalties from Aesculap, Globus Medical, Medtronic, Stryker, Vexim, Spine Wave, and Atlas Spine; serves as a paid consultant to DePuy Synthes, Gerson Lehrman Group, Globus Medical, Guidepoint Global, MEDACorp, Medtronic, Orthobullets, Stryker, Vexim, Spine Wave, Atlas Spine, and Zimmer Biomet; has stock or stock options held in Advanced Spinal Intellectual Property, Avaz Surgical, Bonovo Orthopedics, Computational Biodynamics, CrossCurrent, Cytonics, ElectroCore, Flagship Surgical, Flow Pharma, Gamma Spine, Globus Medical, Innovative Surgical Designs, InVivo Therapeutics, Paradigm Spine, Progressive Spinal Technologies, Replication Medical, Rothman Institute and Related Properties, Spineology, Spine Medica, Stout Medical Group, and Vertiflex; has received research or institutional support from AOSpine; and serves as a board member, owner, officer, or committee member of the American Academy of Orthopaedic Surgeons, Advanced Spinal Intellectual Property, the Association for Collaborative Spine Research, Computational Biodynamics, Innovative Surgical Designs, Progressive Spinal Technologies, and Rothman Institute and Related Properties. Neither Dr. Kreitz nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article.

Received January 20, 2016

Accepted May 12, 2016

© 2017 by American Academy of Orthopaedic Surgeons
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