Multimodal Versus Patient-Controlled Analgesia After an Anterior Cervical Decompression and Fusion

Study Design. Retrospective analysis of a prospectively maintained surgical registry. Objective. To compare postoperative narcotic consumption between multimodal analgesia (MMA) and patient-controlled analgesia (PCA) after an anterior cervical discectomy and fusion (ACDF). Summary of Background Data. Studies suggest that a multimodal approach to pain management leads to decreased pain and morphine consumption after total joint arthroplasty and lumbar spinal procedures. Patients and surgeons would benefit from knowing whether a multimodal approach to pain management is superior to PCA for ACDF. Methods. A retrospective cohort study of ACDF patients receiving either MMA or PCA was conducted. Inpatient narcotic consumption, pain scores, nausea/vomiting, hospital length of stay, and narcotic dependence during the months after surgery were compared between MMA and PCA. Results. A total of 239 patients met inclusion criteria. Of these, 55 (23.0%) received MMA and 184 (77.0%) received PCA. Patients who received MMA had a lower rate of inpatient narcotic consumption (2.5 OME/h vs. 5.8 OME/h, P < 0.001) were less likely to experience nausea/vomiting during the hospitalization (5.5% vs. 37.5%, P < 0.001), and had a shorter hospital length of stay (27.3 vs. 40.1 h, P < 0.001). However, there was no difference between groups in mean visual analogue pain scale during postoperative day zero (4.7 for MMA vs. 5.2 for PCA, P = 0.126) or during postoperative day one (4.1 for MMA vs. 4.1 for PCA, P = 0.937). In addition, there was no difference in the rate of narcotic dependence at the first (P = 0.626) or second (P = 0.480) postoperative visits. Conclusion. These data suggest that MMA results in lower narcotic consumption than PCA after an ACDF. This difference is associated with a shorter inpatient stay and a decrease in postoperative nausea/vomiting. Critically, MMA and PCA appear to provide similar postoperative analgesia. Level of Evidence: 3

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