MULTIMODAL ANALGESIA PRACTICES IN THORACIC SPINAL FUSIONS UTILIZING REMIFENTANIL

Multimodal analgesia has gained favor in analgesic management to improve pain management and minimize opioid use in spinal fusion surgeries. Remifentanil, a short-acting opioid analgesic, is combined with adjuncts such as fentanyl, hydromorphone, methadone, ketamine, dexmedetomidine, lidocaine, and magnesium infusions to produce synergistic pain relief post-surgery. This quality improvement (QI) project evaluated current multimodal and opioid strategies in thoracic spinal fusion procedures using remifentanil infusions as part of a project encompassing cervical, thoracic, and lumbar spinal fusions. The literature review supported multimodal analgesia to combat opioid-induced hyperalgesia. A retrospective chart review of 50 thoracic spinal fusion surgeries at a level one academic medical center examined postoperative pain scores and pain medication administration for patients receiving intraoperative remifentanil infusions with other pain medications. Data were analyzed using linear regression and Pearson’s r correlations. Findings revealed multimodal techniques were employed among anesthesia providers; however, no statistically significant differences were observed in pain scores or postoperative medication administrations based on analgesics used. While multimodal approaches were prevalent, further research is needed to evaluate their effectiveness in reducing postoperative pain. Recommendations include expanding to alternative surgical populations without pre-existing pain conditions and adding comparative groups to enhance understanding of multimodal strategies.