MULTIMODAL ANALGESIA PRACTICES IN LUMBAR SPINAL FUSIONS UTILIZING REMIFENTANIL

Guided by provider judgment, the intraoperative use of specific pain medication combinations can affect patients’ self-reported pain scores in the postoperative recovery room (PACU). While many options are available, commonly used intraoperative analgesics include fentanyl, hydromorphone, methadone, ketamine, dexmedetomidine, lidocaine infusions, and magnesium infusions. As part of a larger quality improvement project analyzing cervical, thoracic, and lumbar spinal fusions, this project sought to identify current practices for multimodal analgesia and narcotic administration in lumbar spinal fusion procedures utilizing remifentanil infusions. The literature review supported the use of multimodal analgesia to combat opioid-induced hyperalgesia. Determining the most effective practice may guide provider practices to help decrease self-reported pain scores and postoperative pain medication usage in the PACU. A retrospective chart review was conducted on 50 patients who underwent lumbar spinal fusion surgeries at a level one academic medical center. Postoperative pain scores and pain medication administration were examined for patients who received intraoperative remifentanil infusion in combination with other pain medications. The findings revealed no statistically significant correlations between intraoperative multimodal analgesia combinations and pain medication administration or pain scores in the PACU. Clinically significant findings included an average pain score in the PACU of 5.14 out of 10, potentially indicating poor pain control. Recommendations include evaluating the postoperative pain control effects of a singular analgesic, such as ketamine, during surgeries utilizing remifentanil infusions, and exploring pain assessment tools that evaluate impact on functional status.