Local infiltration with cocktail analgesics during 2 level lumbar spinal fusion surgery

IntroductionThere has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years, with costs of £26 million to the UK National Health Service annually. Patient dissatisfaction with outcome and persistent pain and disability incurs further costs. Three trials provide low-quality evidence for the role of physiotherapy. Our UK surveys investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. This study will explore the perceptions of patients who undergo LSFS to inform precision rehabilitation.Methods and analysisA qualitative study, using interpretive phenomenological analysis, will recruit a purposive sample (n=40) to ensure patterns of similarity and difference in their journeys can be explored. In-depth semistructured interviews will be undertaken following discharge from hospital and at 12 months postsurgery. Patients’ preoperative and postoperative experiences, underlying attitudes and beliefs towards the surgical intervention, facilitators and barriers to recovery, adherence to advice and physiotherapy, experiences of rehabilitation and return to normal function/activity/work will be explored. A 12-month patient diary will provide real time access to patient data, capturing a weekly record of life as lived, including symptoms, medication, experiences of stages of recovery, rehabilitation adherence, healthcare professional appointments, attitudes, their feelings and experiences throughout their journey. Data will be analysed in a number of stages in accordance with interpretive phenomenological analysis, supported using NVivo software. Analysis of the first interviews and patient diaries will afford a rich density of data to build an overall understanding of the patients’ lived experiences, informing the 12-month interview. Strategies (eg, reflexivity) will ensure trustworthiness.Ethics and disseminationThe study has ethical approval (IRAS 223283). Findings will ensure that patient-driven data inform precision rehabilitation by understanding the patient journey. Findings will be disseminated through peer-reviewed journals and conferences.

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Interdisciplinary Cognitive-Behavioral Therapy as Part of Lumbar Spinal Fusion Surgery Rehabilitation

Orthopaedic Nursing ◽

10.1097/nor.0000000000000259 ◽

2016 ◽

Vol 35 (4) ◽

pp. 238-247 ◽

Cited By ~ 8

Author(s):

Pil Lindgreen ◽

Nanna Rolving ◽

Claus Vinther Nielsen ◽

Kirsten Lomborg

Keyword(s):

Cognitive Behavioral Therapy ◽

Spinal Fusion ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Lumbar Spinal Fusion ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

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90-day Readmission After Lumbar Spinal Fusion Surgery in New York State Between 2005 and 2014

Spine ◽

10.1097/brs.0000000000002208 ◽

2017 ◽

Vol 42 (22) ◽

pp. 1706-1716 ◽

Cited By ~ 15

Author(s):

Ali A. Baaj ◽

Gernot Lang ◽

Wei-Chun Hsu ◽

Mauricio J. Avila ◽

Jialin Mao ◽

...

Keyword(s):

New York ◽

Spinal Fusion ◽

New York State ◽

Lumbar Spinal Fusion ◽

Fusion Surgery ◽

York State ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

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S-ketamine in patient-controlled analgesia reduces opioid consumption in a dose-dependent manner after major lumbar fusion surgery: a randomized, double-blind, placebo-controlled clinical trial

10.1101/2021.01.22.21250352 ◽

2021 ◽

Author(s):

Elina C.V. Brinck ◽

Taru Virtanen ◽

Sanna Mäkelä ◽

Venla Soini ◽

Ville-Veikko Hynninen ◽

...

Keyword(s):

Clinical Trial ◽

Spinal Fusion ◽

Opioid Consumption ◽

Controlled Clinical Trial ◽

Dependent Manner ◽

Lumbar Spinal Fusion ◽

Patient Controlled Analgesia ◽

Fusion Surgery ◽

Spinal Fusion Surgery ◽

Lumbar Spinal

AbstractBACKGROUNDSpinal fusion surgery causes severe pain. Strong opioids, commonly used as postoperative analgesics, may have unwanted side effects. S-ketamine may be an effective analgesic adjuvant in opioid patient-controlled analgesia (PCA). However, the optimal adjunct S-ketamine dose to reduce postoperative opioid consumption is still unknown.METHODSWe randomized 107 patients at two tertiary hospitals in a double-blinded, placebo-controlled clinical trial of adults undergoing major lumbar spinal fusion surgery. Patients were randomly allocated to four groups in order to compare the effects of three different doses of adjunct S-ketamine (0.25, 0.5, and 0.75 mg ml−1) or placebo on postoperative analgesia in oxycodone PCA. Study drugs were administered for 24 hours postoperative after which oxycodone-PCA was continued for further 48 hours. Our primary outcome was cumulative oxycodone consumption at 24 hours after surgery.RESULTSOf the 100 patients analyzed, patients receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA needed 25% less oxycodone at 24 h postoperatively (61.2 mg) compared with patients receiving 0.5 mg ml−1 (74.7 mg) or 0.25 mg ml−1 (74.1 mg) S-ketamine in oxycodone or oxycodone alone (81.9 mg) (mean difference: −20.6 mg; 95% confidence interval [CI]: −41 to −0.20; P = 0.048). A beneficial effect in mean change of pain intensity at rest was seen in the group receiving 0.75 mg ml−1 S-ketamine in oxycodone PCA compared with patients receiving lower ketamine doses or oxycodone alone (standardized effect size: 0.17, 95% CI: 0.013–0.32, P = 0.033). The occurrence of adverse events was similar among the groups.CONCLUSIONSOxycodone PCA containing S-ketamine as an adjunct at a ratio of 1: 0.75 decreased cumulative oxycodone consumption at 24 h after major lumbar spinal fusion surgery without additional adverse effects.

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