Multimodal approach to pain management in patients undergoing spinal fusion for chronic pain.

摘要

Chronic back pain after lumbar intervertebral fusion is a problem that affect over 15% of all patients.1-3 Chronic pain can have far reaching negative outcomes for patients and current treatment modalities fail to effectively reduce chronic pain in the lumbar fusion patient. Alternative analgesic medications, including N-methyl-D-aspartate inhibitors, &agr;2 agonists, and gabapentinoids, may prove useful in the prevention of chronic pain following spinal surgery.;Ketamine, clonidine, and pregabalin have all proven useful in the treatment of chronic neuropathic pain and recent clinical trial have shown evidence that these medications decrease perioperative opioid requirements in patients undergoing spinal fusion surgery. However, the effect of these analgesic adjuncts on the incidence of chronic pain after spinal fusion has not been well studied. We hypothesize that using ketamine, pregabalin, and clonidine will decrease the incidence of chronic pain in patients undergoing lumbar spinal fusion surgery.;This is a proposal for a randomized, prospective, doubled-blinded clinical trial comparing pain scores and opioid requirements between a control and an experimental group for 58 patients undergoing lumbar intervertebral fusion surgery. The experimental group will receive a multimodal analgesic therapy consisting of oral clonidine and pregabalin along with a ketamine infusion. Outcome measures include pain scores and opioid requirements within the first 48 postoperative hours and again at 3 months after surgery.