Article ; Online: Opioid-Free Analgesia is Safe and Effective in Anterior Cervical Spine Surgery: A Randomized Controlled Trial.
2024 Volume 37, Issue 4, Page(s) 138–148
Abstract: Study design: Randomized controlled trial (RCT).: Objective: Compare the efficacy of a multimodal, opioid-free (OF) pain management pathway with a traditional opioid-containing (OC) pathway in patients undergoing anterior cervical procedures.: ... ...
| Abstract | Study design: Randomized controlled trial (RCT). Objective: Compare the efficacy of a multimodal, opioid-free (OF) pain management pathway with a traditional opioid-containing (OC) pathway in patients undergoing anterior cervical procedures. Summary of background data: Previous studies have compared opioid-based pain regimens to opioid-sparing regimens following cervical spine surgery, but have been limited by high rates of crossover, retrospective designs, reliance on indwelling pain catheters, opioid utilization for early postoperative analgesia, and/or a lack of patient-reported outcome measures. Methods: This is a RCT in which patients were allocated to either an OF or OC perioperative pain management protocol. Eligible study participants included adult (age up to 18 y) patients who underwent primary, 1-level or 2-level anterior cervical surgery [anterior cervical discectomy and fusion (ACDF), anterior cervical disc arthroplasty (ACDA), or hybrid (ACDF and ACDA at different levels)] for degenerative pathology. The primary outcome variable was subjective pain level at 24 hours postoperative. The final study cohort consisted of 50 patients (22 OF, 28 OC). Results: Patients in the OF group reported lower median postoperative pain levels at 6 hours (4 for OF vs. 7 for OC; P =0.041) and 24 hours (3 for OF vs. 5 for OC; P =0.032). At 2-week and 6-week follow-up, pain levels were similar between groups. Patients in the OF group reported greater comfort at 12 hours (9 for OF vs. 5 for OC; P =0.003) and 24 hours (9 for OF vs. 5 for OC; P =0.011) postoperatively. Notably, there were no significant differences in patients' reported pain satisfaction, overall surgical satisfaction, or overall sense of physical and mental well-being. In addition, there were no significant differences in falls, delirium, or constipation postoperatively. Conclusions: A multimodal OF pain management pathway following anterior cervical surgery for degenerative disease results in statistically noninferior pain control and equivalent patient-reported outcome measures compared with a traditional OC pathway. |
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| MeSH term(s) | Humans ; Male ; Female ; Cervical Vertebrae/surgery ; Middle Aged ; Pain, Postoperative/etiology ; Pain, Postoperative/drug therapy ; Analgesics, Opioid/therapeutic use ; Adult ; Treatment Outcome ; Pain Management ; Pain Measurement ; Analgesia ; Spinal Fusion/adverse effects | |||||
| Chemical Substances | Analgesics, Opioid | |||||
| Language | English | |||||
| Publishing date | 2024-03-28 | |||||
| Publishing country | United States | |||||
| Document type | Journal Article ; Randomized Controlled Trial | |||||
| ZDB-ID | 2849646-2 | |||||
| ISSN | 2380-0194 ; 2380-0186 | |||||
| ISSN (online) | 2380-0194 | |||||
| ISSN | 2380-0186 | |||||
| DOI | 10.1097/BSD.0000000000001608 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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