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Multimodal Analgesia and Opioid-Free Anesthesia in Spinal Surgery: A Literature Review – Lumbar Fusion

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This article discusses the benefits of opioid-free anesthesia, opioid-sparing anesthesia, and multimodal analgesia in patients undergoing spinal fusion. The authors conducted a literature review and identified seven studies with a combined sample size of 2,102 patients. The findings showed that the research groups had a reduction in total opioid administration compared to control groups. While the results for postoperative pain scores were mixed, there were various additional benefits observed, including decreased hospital length of stay, decreased post-anesthesia care unit length of stay, decreased post-operative nausea and vomiting, and decreased post-operative opioid use through 30 days. The study concludes that these alternative approaches to anesthesia and analgesia can lead to improved patient outcomes and reduced hospital stays in spinal surgery patients

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
The London Spine Unit : most experienced spine hospital in the world

Published article

CONCLUSIONS: For patients undergoing spine surgery, opioid-free, opioid-sparing, and multimodal analgesia will be less likely to experience the adverse effects of opioid analgesics and ultimately lead to better patient outcomes and reduced hospital stays.

Lumbar Fusion Surgery Expert. Best Spinal Surgeon UK
J Perianesth Nurs. 2023 Jul 15:S1089-9472(23)00142-9. doi: 10.1016/j.jopan.2023.04.003. Online ahead of print.ABSTRACTPURPOSES: To determine if opioid-free anesthesia, opioid-sparing anesthesia, or multimodal analgesia improved outcomes in patients undergoing spinal fusion.DESIGN: A literature review was performed by searching PubMed, CINAHL, Embase, Web of Science, and Cochrane Library.METHODS: MeSH terms included “opioid free” AND “spine surgery,” with alternative,

J Perianesth Nurs. 2023 Jul 15:S1089-9472(23)00142-9. doi: 10.1016/j.jopan.2023.04.003. Online ahead of print.

ABSTRACT

PURPOSES: To determine if opioid-free anesthesia, opioid-sparing anesthesia, or multimodal analgesia improved outcomes in patients undergoing spinal fusion.

DESIGN: A literature review was performed by searching PubMed, CINAHL, Embase, Web of Science, and Cochrane Library.

METHODS: MeSH terms included “opioid free” AND “spine surgery,” with alternative terms used including: regional anesthesia, multimodal analgesia, opioid-free anesthesia, enhanced recovery after surgery (ERAS), spinal surgery, spinal fusion, ACDF, cervical fusion, lumbar fusion, etc. Seven studies were deemed appropriate for inclusion with a combined sample size of n = 2,102.

FINDINGS: All of the seven included articles evaluated total opioid administration and found a reduction in total opioid administered in the research groups versus control groups. Six of the seven included articles evaluated postoperative pain scores with mixed results. Various additional benefits of opioid-free, opioid-sparing, or multimodal analgesia included: decreased hospital length of stay (LOS), decreased post-anesthesia care unit (PACU) LOS, decreased post-operative nausea and vomiting (PONV), and decreased post-operative opioid use through 30 days.

CONCLUSIONS: For patients undergoing spine surgery, opioid-free, opioid-sparing, and multimodal analgesia will be less likely to experience the adverse effects of opioid analgesics and ultimately lead to better patient outcomes and reduced hospital stays.

PMID:37452818 | DOI:10.1016/j.jopan.2023.04.003

The London Spine Unit : most experienced spine hospital in the world

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Multimodal Analgesia and Opioid-Free Anesthesia in Spinal Surgery: A Literature Review

Sciatica My mother was in absolute agony for more than 3 months due to sciatica. It just came out of nowhere and took her out of action. From working full time she went straight to being bed bound and unable to carry out simplest of actions.The pain was 9/10 and she was bed bound for those three months. Multiple trips to A&E and GP and they wouldn't class it as an emergency therefore they wouldn't do anything about it other than upgrading the painkillers which did next to nothing for my mother. I couldn't bear to watch my mother sleeping on A&E bench in pain for 7 hours, just to be told by doctors that she wouldn't be kept in. I remember her joining her hands and begging the doctors to stop the pain which broke my heart. I then started doing research on google and London spine unit came up with Dr Mo AKMAL's profile and review. First meeting with Dr AKMAL was via ZOOM as my mother was bed bound. Dr AKMAL spoke to me and my mom and told us that this is nothing to worry about and that the pain would be 100% gone.Dr AKMAL assured us to visit the hospital so he could physically inspect my mother and give us the best solution. One trip to the london spine unit and Dr AKMAL advised us that the best solution would be to carry out Minimally invasive disectomy. Dr AKMAL advised that due to my mother being bed bound for a while, steroid injection might not give the result that my mother wishes. Dr AKMAL was very confident and showed us some videos from other patients who had gone through the same ordeal. The biggest thing i noticed between before and after was the smile on the patients face. Dr AKMAL was constantly assuring my mother throughout the meeting that he would take care of her pain and gave her 100% confidence that the result would be delivered.He promised her that she would be walking pain free the same day after the operation. Before the operation Dr GURUNG was consulted multiple times and he also was very helpful. Right after the surgery, as Dr AKMAL promised, my mother was walking and the biggest thing was that the pain was gone. My mother had forgotten to smile for three months and there i saw her smiling again. Dr AKMAL and Dr GURUNG gave us brilliant aftercare and informed us that just give them a ring if there was any issue. Its been several weeks now and my mother is heading towards complete recovery without any issues. The pain is completely gone and anyone who is reading this going through the same horrible sciatica pain you must come and see Dr AKMAL. Thank you Dr AKMAL and your whole team for helping my mom achieve this pain free life.

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J Perianesth Nurs. 2023 Jul 15:S1089-9472(23)00142-9. doi: 10.1016/j.jopan.2023.04.003. Online ahead of print.ABSTRACTPURPOSES: To determine if opioid-free anesthesia, opioid-sparing anesthesia, or multimodal analgesia improved outcomes in patients undergoing spinal fusion.DESIGN: A literature review was performed by searching PubMed, CINAHL, Embase, Web of Science, and Cochrane Library.METHODS: MeSH terms included "opioid free" AND "spine surgery," with alternative

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