A Multimodal Pain Regimen in Thoracolumbar Spine Surgery Patients Is Associated With Improved Postoperative Recovery and Disposition.

Abstract

Multimodal analgesia (MMA) is an alternative to patient-controlled analgesia (PCA) that reduces opioid usage after spine surgery and improves time to mobilization. The purpose of this study was to investigate whether MMA improves physical therapy performance, hospital length of stay (LOS), and disposition to home following major spinal reconstructive surgery. The study is a pre- and postintervention retrospective cohort study evaluating a unique MMA protocol developed and implemented at our institution in 2022. Data were collected for patients who received PCA for 1 year before MMA implementation and patients who received MMA for 1-year postimplementation. All patients who underwent open, posterior lumbar fusion surgery ± decompression between 2 and 5 levels were included. Minimally invasive, anterior, and lateral procedures were excluded from the study. Data collected included numeric pain scores (0 to 10), LOS, and disposition to home versus inpatient rehabilitation. Chi-squared analysis was used to calculate P values, which were considered notable if P < 0.05. Logistic regression was used to model patient disposition status. Overall, there were 235 patients in the MMA group and 192 in the PCA group (total n = 427). Patient demographics were similarly matched between the cohorts. The MMA group demonstrated markedly longer walking distance (feet) at all stages of the postoperative period. The MMA group demonstrated shorter LOS and increased likelihood of being discharged home versus inpatient rehabilitation. Logistic regression analysis revealed 2.96 times increased odds of home discharge after MMA. Our MMA protocol was superior to PCA in treating pain and improving LOS and disposition status in patients undergoing multilevel spinal fusion. Our findings suggest that MMA may be preferable to PCA in the treatment of postoperative pain after multilevel thoracolumbar spinal fusions.