Standardized multimodal pain protocol reduced pain, opioid consumption after fusion

LOS ANGELES — Results presented at the North American Spine Society Annual Meeting showed significant improvement in patients’ average pain scores following the implementation of a quality improvement initiative that included a pain protocol that used maximized, standardized nonopioid medication. Pain scores improved in the first 72 hours after surgery, in addition to a drastic reduction in opioid prescriptions, according to results presented by Corey Walker, MD, of Barrow Neurological Institute in Phoenix.

Walker and colleagues used cohorts of patients who underwent traditional lumbar spine fusion and compared reported pain scores in 115 patients treated before implementation of the pain protocol and in 126 patients treated after implementation of the protocol. The protocol, which was evidence-based, included a short course of NSAIDs, acetaminophen, topical lidocaine patches, scheduled muscle relaxants, gabapentinoids and opioids as needed as a breakthrough medication. Specifically, researchers retrospectively studied pain outcomes in patients the first year after open, traditional lumbar fusion.

In the pain protocol group, average patient-reported numeric rating scale pain scores improved significantly postoperatively in the first 24 hours, as well as at 24 to 72 hours. The pain protocol group experienced a decreased length of hospital stay of 4.7 vs. 3.9 days in the pre-protocol group.

When Walker presented the results, he discussed the importance of a decrease in opioid consumption and its impact on hospital stay.

“Most importantly, we were able to do this with a concomitant reduction in opioid prescription in the 72 hours after surgery,” Walker said. “We were able to decrease the number from 110 to 71 morphine milli-equivalents in this time period, and this was statistically significant. In association with these improvements, we saw nearly a full-day reduction in hospital length of stay. When we specifically looked at opioid-related adverse events, the total number of events per patient was reduced with the protocol.”

According to Walker, Barrow Neurological Institute has extended use of this protocol to its cranial surgery group. – by Joseph Gramigna

Reference:

Walker C, et al. Paper 70. Presented at: North American Spine Society Annual Meeting; Sept. 26-29, 2018; Los Angeles.

Disclosure: Walker reports no relevant financial disclosures.