The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery

Abstract

Background. Due to the presence of multimorbidity and polypharmacy, patients aged 75 and older are at a higher risk for postoperative adverse events after lumbar fusion surgery. More effective enhanced recovery pathway is needed for these patients. Pain control is a crucial part of perioperative management. The objective of this study is to determine the impact of multimodal pain management on pain control, opioid consumption, and other outcomes. Methods. This is a retrospective review of a prospective collected database. Consecutive patients who underwent elective posterior lumbar fusion surgery (PLF) from October 2017 to April 2021 in our hospital were reviewed. Perioperative multimodal pain management (PMPM) group (from January 2019 to April 2021) in which patients received multimodal analgesia was case-matched to the control group (from October 2017 to December 2018) in which patients were treated under the conventional patient-controlled analgesia (PCA) method. Postoperative visual analogue scale (VAS), opioid consumption, complications within 3 months, and other outcomes were collected and compared between groups. Results. A total of 122 consecutive patients (aged 75 and older) were included in the PMPM group and compared with previous 122 patients. The PMPM group had a lower maximal VAS score (3.0 ± 1.7 vs. 3.7 ± 2.0, $p<0.001$ ) and frequency of additional opioid consumption (6.6% vs. 19.7%, $p=0.001$ ) on POD3 than the control group. The rates of postoperative complications were lower in the PMPM group compared with the control group (25% vs. 49%, $p=0.006$ ) during a 3-month follow-up period. Conclusions. This study demonstrates that the PMPM protocol is effective in pain control and reducing additional opioid consumption when compared with conventional analgesia, even for patients aged 75 and older. Moreover, these improvements occur with a lower incidence of postoperative complications within three months after PLF surgery.