90. Impact of patient-controlled analgesia on clinical outcomes after posterior lumbar spinal fusion surgery

Abstract

BACKGROUND CONTEXT Optimal postoperative pain control is critical after spinal fusion surgery. Significant variability remains in the use of postoperative intravenous opioid patient-controlled analgesia (PCA) and very little data evaluating its utility compared to nurse-controlled analgesia (NCA) in lumbar fusion patients. PURPOSE We performed a retrospective evaluation of posterior lumbar spinal fusion patients being treated postoperatively with patient-controlled analgesia (PCA) and compared their pain-related outcomes to nurse-controlled analgesia (NCA). PCA utilization was independently associated with increased opioid prescription in the postoperative period. After controlling for preoperative opioid use, we found that opioid naive patients have worse pain control with PCA than NCA, and patients with very high opioid consumption (>90 MME/day) had greater rates of opioid-related adverse events with PCA. STUDY DESIGN/SETTING Retrospective clinical study, single institution. PATIENT SAMPLE A retrospective review from a single institution was conducted in consecutive patients treated with posterior lumbar spinal fusion for degenerative pathology. Patients with scoliosis, traumatic, neoplastic, infectious and minimally invasive treatments were excluded. OUTCOME MEASURES Postoperative numerical rating scale (NRS) pain scores, length of stay, and total opioid consumption were collected and compared. Opioid-related adverse events for each patient were also measured. METHODS Patients were divided into two cohorts: those treated postoperatively with PCA or NCA. Outcome measures were compared for patients in groups. Patients were stratified according to preoperative opioid consumption as naive, low (60 morphine milligram equivalents (MME) daily), high (61-90 MME) or very high (>90 MME) for analysis. RESULTS A total of 240 patients were identified: 62 and 178 patients in PCA and NCA groups, respectively. PCA patients had higher mean preoperative opioid consumption compared to the NCA group (49.2 vs 24.3 MME, p=0.009). PCA patients had higher mean opioid consumption in first 72 hours in all preoperative opioid consumption categories. Pain control and adverse event rates were similar between PCA and traditional opioid therapy in the low to high preoperative opioid consumption groups (>0 to 90 MME daily). Opioid naive patients had worse mean and highest NRS pain scores in the first 72 hours (all p 90 MME daily) had a greater rate of opioid-related adverse events (95% vs 70%, p CONCLUSIONS Postoperative PCA utilization is associated with significantly more opioid consumption and equal or worse postoperative pain scores compared to NCA after lumbar spinal fusion surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.