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Research ArticleLumbar Spine

A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study

Michael Markowitz, Barrett Woods, Gregory Schroeder, Christopher Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alexander Vaccaro and Kris Radcliff
International Journal of Spine Surgery December 2023, 17 (6) 828-834; DOI: https://doi.org/10.14444/8484
Michael Markowitz
1 Rowan University School of Osteopathic Medicine Orthopedic Surgery, Stratford, NJ, USA
DO
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Barrett Woods
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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Gregory Schroeder
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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Christopher Kepler
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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David Kaye
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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Mark Kurd
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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Joshua Armstrong
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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Alexander Vaccaro
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD, PʜD
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Kris Radcliff
2 The Rothman Institute at Thomas Jefferson University Hospital, Philadelphia, PA, USA
MD
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  • For correspondence: kris.radcliff@rothmanortho.com
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    Figure 1

    Average pain scores in the preprotocol vs protocol cohorts by postoperative day.

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    Figure 2

    Correlation of patient-reported pain and morphine equivalent consumption over postoperative day (POD).

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    Table

    Perioperative multimodal pain protocol administered to protocol patients.

    PreoperativeIntraoperativePostoperative
    Gabapentin 900 mg orally for 1 doseIV acetaminophen 1000 mg every 6 h for 3 dosesGabapentin 300 mg 3 times per day for 5 d
    Celecoxib 200 mg orally for 1 dose (no renal risk)IV lidocaine 2 mg/kg/hCelecoxib 200 mg orally for 5 d
    IV dexamethasone 10 mg for 1 doseAdditional pain medication as needed
    Injectable liposomal bupivacaine 30 mL with bupivacaine in epinephrine 30 mL
    • Abbreviation: IV, intravenous.

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International Journal of Spine Surgery
Vol. 17, Issue 6
1 Dec 2023
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A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study
Michael Markowitz, Barrett Woods, Gregory Schroeder, Christopher Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alexander Vaccaro, Kris Radcliff
International Journal of Spine Surgery Dec 2023, 17 (6) 828-834; DOI: 10.14444/8484

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A Novel Multimodal Postoperative Pain Protocol for 1- to 2-Level Open Lumbar Fusions: A Retrospective Cohort Study
Michael Markowitz, Barrett Woods, Gregory Schroeder, Christopher Kepler, David Kaye, Mark Kurd, Joshua Armstrong, Alexander Vaccaro, Kris Radcliff
International Journal of Spine Surgery Dec 2023, 17 (6) 828-834; DOI: 10.14444/8484
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More in this TOC Section

  • Recovery Trajectories After Lumbar Fusion Stratified by Baseline Patient-Reported Outcomes Measurement Information System Physical Function Disability Levels
  • Safety and Viability of Anterior Lumbar Interbody Fusion in Complex Revision Lumbar Spine Surgeries: Insights From a Case Series of 135 Patients on Transforaminal Lumbar Interbody Fusion/Posterior Lumbar Interbody Fusion Cage Removal
  • Effects of Body Mass Index on Spondylolisthesis Surgery and Associated Patient-Reported Outcomes: A Retrospective Review
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Keywords

  • multimodal analgesia
  • 1- to 2-level lumbar fusion
  • reduced opioid consumption after lumbar fusion
  • pain management
  • lidocaine
  • opioid
  • narcotic
  • morphine
  • spine fusion
  • gabapentin
  • acetaminophen
  • postoperative pain

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