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Abdelhaleem NF. Response to comments on "Analgesic efficacy of inter-semispinal fascial plane block in patients undergoing cervical spine surgery through posterior approach: a randomized controlled trial.". Anaesth Crit Care Pain Med 2024; 43:101362. [PMID: 38428525 DOI: 10.1016/j.accpm.2024.101362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2024]
Affiliation(s)
- Naglaa Fathy Abdelhaleem
- Anesthesia and Surgical Intensive Care Department, Faculty of Medicine, Zagazig University, Zagazig 44519, Egypt.
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Zabat MA, Mottole NA, Ashayeri K, Norris ZA, Patel H, Sissman E, Balouch E, Maglaras C, Protopsaltis TS, Buckland AJ, Fischer CR. Comparative Analysis of Inpatient Opioid Consumption Between Different Surgical Approaches Following Single Level Lumbar Spinal Fusion Surgery. Global Spine J 2023; 13:2508-2515. [PMID: 35379014 PMCID: PMC10538336 DOI: 10.1177/21925682221089244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Single-center retrospective cohort study. OBJECTIVES To evaluate inpatient MME administration associated with different lumbar spinal fusion surgeries. METHODS Patients ≥18 years of age with a diagnosis of Grade I or II spondylolisthesis, stenosis, degenerative disc disease or pars defect who underwent one-level Transforaminal Lumbar Interbody Fusion (TLIF) or one-level Anterior Lumbar Interbody Fusion (ALIF) or Lateral Lumbar Interbody Fusion (LLIF) through traditional MIS, anterior-posterior position or single position approaches between L2-S1. Outcome measures included patient demographics, surgical procedure and approach, perioperative clinical characteristics, incidence of ileus and inpatient MME. Statistical analysis included one-way ANOVA with a post-hoc Tukey Test and Kruskal-Wallis Test with post-hoc Mann-Whitney test. MME was calculated as per the Centers for Medicare and Medicaid Services and previous literature. Significance set at P < .05. RESULTS Mean age differed significantly between MIS TLIF (55.6 ± 12.5 years) and all other groups (Open TLIF 57.1 ± 12.5, SP ALIF/LLIF 57.9 ± 9.9, TP ALIF/LLIF 50.9 ± 12.7, Open ALIF/LLIF 58.4 ± 15.5). MIS TLIF had the shortest LOS compared to all groups except SP ALIF/LLIF. Total MME was significantly different between MIS TLIF and Open ALIF/LLIF (172.5 MME vs 261.1 MME, P = .044) as well as MIS TLIF and TP ALIF/LLIF (172.5 MME vs 245.4 MME, P = .009). There were no significant differences in MME/hour and incidence of ileus between all groups. CONCLUSION Patients undergoing MIS TLIF had lower inpatient opioid intake compared to TP and SP ALIF/LLIF, as well as shorter LOS compared to all groups except SP ALIF/LLIF. Thus, it appears that the advantages of minimally invasive surgery are seen in minimally invasive TLIFs.
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Affiliation(s)
- Michelle A. Zabat
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Nicole A. Mottole
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Kimberly Ashayeri
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Zoe A. Norris
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Hershil Patel
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Ethan Sissman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Eaman Balouch
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Constance Maglaras
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | | | - Aaron J. Buckland
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Charla R. Fischer
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
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Singh R, Yadav A, Varshney PG. Case series on use of intrathecal morphine in pediatric thoracic spine surgeries. Saudi J Anaesth 2023; 17:245-248. [PMID: 37260661 PMCID: PMC10228851 DOI: 10.4103/sja.sja_680_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 06/02/2023] Open
Abstract
Intrathecal morphine is a very good analgesic agent and was used frequently in the past. Its use has decreased over the years due to side effects such as respiratory depression, nausea, vomiting, pruritis, and so on. Also, with the introduction of drugs like clonidine and the availability of ultrasonography for regional blocks, the role of morphine has declined. Yet, there are surgeries where intrathecal morphine supersedes all other analgesic modalities to provide excellent intraoperative and postoperative analgesia.
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Affiliation(s)
- Ranju Singh
- Department of Anaesthesiology and Intensive Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Ayushi Yadav
- Department of Anaesthesiology and Intensive Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
| | - Preeti G. Varshney
- Department of Anaesthesiology and Intensive Care, Lady Hardinge Medical College and Associated Hospitals, New Delhi, India
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A machine learning algorithm for predicting prolonged postoperative opioid prescription after lumbar disc herniation surgery. An external validation study using 1,316 patients from a Taiwanese cohort. Spine J 2022; 22:1119-1130. [PMID: 35202784 DOI: 10.1016/j.spinee.2022.02.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 01/31/2022] [Accepted: 02/14/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Preoperative prediction of prolonged postoperative opioid prescription helps identify patients for increased surveillance after surgery. The SORG machine learning model has been developed and successfully tested using 5,413 patients from the United States (US) to predict the risk of prolonged opioid prescription after surgery for lumbar disc herniation. However, external validation is an often-overlooked element in the process of incorporating prediction models in current clinical practice. This cannot be stressed enough in prediction models where medicolegal and cultural differences may play a major role. PURPOSE The authors aimed to investigate the generalizability of the US citizens prediction model SORG to a Taiwanese patient cohort. STUDY DESIGN Retrospective study at a large academic medical center in Taiwan. PATIENT SAMPLE Of 1,316 patients who were 20 years or older undergoing initial operative management for lumbar disc herniation between 2010 and 2018. OUTCOME MEASURES The primary outcome of interest was prolonged opioid prescription defined as continuing opioid prescription to at least 90 to 180 days after the first surgery for lumbar disc herniation at our institution. METHODS Baseline characteristics were compared between the external validation cohort and the original developmental cohorts. Discrimination (area under the receiver operating characteristic curve and the area under the precision-recall curve), calibration, overall performance (Brier score), and decision curve analysis were used to assess the performance of the SORG ML algorithm in the validation cohort. This study had no funding source or conflict of interests. RESULTS Overall, 1,316 patients were identified with sustained postoperative opioid prescription in 41 (3.1%) patients. The validation cohort differed from the development cohort on several variables including 93% of Taiwanese patients receiving NSAIDS preoperatively compared with 22% of US citizens patients, while 30% of Taiwanese patients received opioids versus 25% in the US. Despite these differences, the SORG prediction model retained good discrimination (area under the receiver operating characteristic curve of 0.76 and the area under the precision-recall curve of 0.33) and good overall performance (Brier score of 0.028 compared with null model Brier score of 0.030) while somewhat overestimating the chance of prolonged opioid use (calibration slope of 1.07 and calibration intercept of -0.87). Decision-curve analysis showed the SORG model was suitable for clinical use. CONCLUSIONS Despite differences at baseline and a very strict opioid policy, the SORG algorithm for prolonged opioid use after surgery for lumbar disc herniation has good discriminative abilities and good overall performance in a Han Chinese patient group in Taiwan. This freely available digital application can be used to identify high-risk patients and tailor prevention policies for these patients that may mitigate the long-term adverse consequence of opioid dependence: https://sorg-apps.shinyapps.io/lumbardiscopioid/.
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The Impact of Perioperative Multimodal Pain Management on Postoperative Outcomes in Patients (Aged 75 and Older) Undergoing Short-Segment Lumbar Fusion Surgery. Pain Res Manag 2022; 2022:9052246. [PMID: 35265235 PMCID: PMC8898790 DOI: 10.1155/2022/9052246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 01/26/2022] [Accepted: 01/31/2022] [Indexed: 11/18/2022]
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.
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Chen CJ, Shah AA, Hsiue PP, Subhash AK, Lord EL, Park DY, Stavrakis AI. Acute Colonic Pseudo-Obstruction (Ogilvie Syndrome) After Primary Spinal Fusion: An Analysis of Outcomes and Risk Factors from 2005 to 2014. World Neurosurg 2021; 155:e612-e620. [PMID: 34481105 DOI: 10.1016/j.wneu.2021.08.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Ogilvie syndrome (OS) is a rare but serious condition seen in the postoperative period. This was an epidemiologic study using data from the National Inpatient Sample from 2005 to 2014 to look at incidence, risk factors, and outcomes associated with OS after primary spine fusion. METHODS International Classification of Diseases, Ninth Revision codes were used to identify patients who underwent spine fusion surgery. Patients were separated into 2 cohorts based on the diagnosis of OS. Outcome measures and risk factors for cohorts were analyzed using multivariate logistic regression and compared. RESULTS Over the 10-year study period, 3,884,395 patients underwent primary spine fusion surgery. Among these, 0.04% developed OS during the index hospitalization. The greatest incidence seen in primary fusion involved the thoracic spine (0.15%). OS was more common after spine fusion for spine deformity (P < 0.001). Patients with OS were more likely to be men (P < 0.001), older (P < 0.0001), and have more comorbidities (P < 0.0001). Patients with OS were more likely to require postoperative blood transfusions (odds ratio [OR], 3.39; 95% confidence interval [CI], 2.51-4.59; P < 0.001) and sustain any complication (OR, 4.20; 95% CI, 3.17-5.57; P < 0.001). Patients with OS had a longer length of stay (15.7 vs. 3.9 days; P < 0.001) and increased average hospitalization cost ($63,037.03 vs. $26,792.19; P < 0.001). The development of OS was associated with fluid electrolyte disorder (OR, 4.06; 95% CI, 2.99-5.51; P < 0.001). CONCLUSIONS OS is a rare but serious complication of primary spine fusion surgery. Identifying the specific risk factors, symptoms, and potential complications related to OS is critical to aid in decreasing the significant morbidity associated with its development.
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Affiliation(s)
- Clark J Chen
- Department of Orthopaedic Surgery, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
| | - Akash A Shah
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Peter P Hsiue
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Ajith K Subhash
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Elizabeth L Lord
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Don Y Park
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Alexandra I Stavrakis
- Department of Orthopaedic Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
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Tirrell AR, Abu El Hawa AA, Bekeny JC, Fan KL, Del Corral G. Minimizing opioid consumption by eliminating patient-controlled analgesia after penile inversion vaginoplasty with enhanced recovery after surgery (ERAS) protocol. Andrology 2021; 10:232-240. [PMID: 34392611 DOI: 10.1111/andr.13095] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 06/23/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genital-based gender affirmation surgery is a physically demanding procedure requiring extensive postoperative pain management. However, perioperative opioid use for these procedures is relatively understudied. OBJECTIVES This study analyzes whether intravenous patient-controlled analgesia (PCA) enhances pain control after penile inversion vaginoplasty (PIV) in the setting of enhanced recovery after surgery (ERAS) protocols, and whether non-PCA (NCA)-based regimens could reduce postoperative opioid use. METHODS All patients undergoing PIV with ERAS protocols by a single provider from December 2018 to November 2020 were retrospectively reviewed. Patient demographics, comorbid conditions, pain scores, length of stay (LOS), and opioid usage during their hospitalization were collected. Postoperative opioid use and pain scores were compared between PCA and NCA patient cohorts. RESULTS A total of 61 patients were included. 30 patients received intravenous PCA postoperatively, and 31 patients used NCA-based narcotic pain control. All patients underwent ERAS protocol perioperatively. Average patient age was 34.5 years (SD 11.9) in the PCA cohort and 37.6 years (SD 11.9) in the NCA cohort (p = 0.242). Average total postoperative opioid use during hospital stay was reduced by 53.7% in the NCA cohort, with an average use of 501.6 morphine milligram equivalents (MME) (SD 410.3) among PCA patients and an average use of 232.0 MME (SD 216.5) among NCA patients (p = 0.003). Daily average pain scores for postoperative days 1 to 6 did not differ between the PCA and NCA patient groups (p > 0.05). Average hospital LOS was shorter among NCA patients, 6.2 days (SD 1.0) versus 7.3 days (SD 1.4), respectively, (p < 0.001). DISCUSSION In combination with an ERAS non-narcotic pain control protocol, it may be possible to reduce opioid use by more than 50% and shorten length of postoperative hospital stay among patients by implementing NCA pain management protocols. CONCLUSION Minimizing postoperative opioid consumption after PIV will benefit patients and their sustained well-being.
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Affiliation(s)
- Abigail R Tirrell
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Areeg A Abu El Hawa
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Jenna C Bekeny
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
| | - Gabriel Del Corral
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia, USA
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Jenkins NW, Parrish JM, Singh K. Commentary: Patient-Controlled Analgesia Following Lumbar Spinal Fusion Surgery Is Associated With Increased Opioid Consumption and Opioid-Related Adverse Events. Neurosurgery 2020; 87:E311-E312. [PMID: 32357227 DOI: 10.1093/neuros/nyaa120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 02/20/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Nathaniel W Jenkins
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - James M Parrish
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Kern Singh
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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