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No difference in pain relief was found after spine surgery using Morphine or Ketorolac

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Created On: 20/07/2020

No difference in pain relief was found after spine surgery using Morphine or Ketorolac

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Key take away

The study results depicted that multimodal wound infiltration with an NSAID and morphine did not yield any clinically significant minimization in pain or opioid consumption. No pivotal benefit of adding these drugs to a patient's aftercare regimen was attained. Taking into consideration the potential risks of administering opioids and NSAIDs (such as serious adverse events of NSAIDs, and polypharmacy in geriatrics), routine use of this approach in clinical practice is not recommended.

Background

This randomized, double-blind, controlled clinical trial after lumbar interbody fusion was conducted to assess (a) Whether multimodal analgesia lower VAS (visual analog scale) pain scores by a clinically important amount (b) Does this analgesic approach minimize the amount of morphine patients consume after their surgery (c) Is this technique linked with fewer opioid-related side effects after surgery.

Method

This study recruited 80 adult patients undergoing lumbar interbody fusion. The participants were randomly assigned into two groups: (1) Control group (n = 40) who received infiltration of the surgical incision at the end of the procedure with an injection of epinephrine 0.5 mg (0.5 mL) and 0.5% bupivacaine 100 mg (20 mL) (2) Multimodal group (n = 40), who received wound infiltration with the similar technique but with different medications: ketorolac 30 mg (1 mL), 0.5% bupivacaine 92.5 mg (18.5 mL), morphine 5 mg (0.5 mL), and epinephrine 0.5 mg (0.5 mL).

Using the VAS, pain at rest was recorded. Postoperative morphine consumption (given utilizing a patient-controlled analgesia pump) and opioid-related side effects were examined. The evaluation was performed considering intention-to-treat principles. No loss to follow-up or protocol deviations were witnessed. A 2-cm change on a 10-cm scale on the VAS was considered as MCID (minimum clinically important difference). Differences smaller than these were not found to be clinically significant.

Result

No between-group differences in the VAS scores that exceeded the MCID were witnessed. The administration of multimodal injections is not linked to pain reductions. At 3 hours, the highest treatment effect was noted that showed only a -1.3 cm mean difference (below the MCID) between both the groups. Morphine consumption was very slightly higher in the Control group than in the Multimodal group as shown in Table 1:

The percentage of patients reporting opioid-related side effects was lower in the Multimodal group than in the Control group. The proportions of nausea and vomiting were elevated in the Control group than in comparison with the Multimodal group. All of these side effects were transient and none was severe as depicted in Table 2: