Multimodal Analgesic Management for Lumbar Decompression Surgery in the Ambulatory Setting: Clinical Case Series and Review of the Literature.

Abstract

BACKGROUND\nEffective pain control is vital for successful surgery in the ambulatory setting. Our study aims to characterize a case series of patients who underwent lumbar decompression (LD) in the ambulatory surgical center (ASC) with the use of a multimodal analgesic (MMA) protocol.\n\n\nMETHODS\nA prospective surgical registry was retrospectively assessed for patients who underwent single or multilevel LD in an ASC using MMA from 2013-2019. Observation in excess of 23 hours was not permitted at the ASC and patients were required to be discharged the same day. Length of stay, patient-reported visual analogue scale (VAS) pain scores prior to discharge, and the quantity of narcotic medications administered to patients prior to discharge were recorded. Quantity of narcotic medications were converted into units of oral morphine equivalents (OME) and summed across all types of narcotic medications prescribed.\n\n\nRESULTS\nA total of 499 patients were included. 86.0% (429) of the patients that underwent a single level decompression procedure, 13.8% (69) of patients underwent a two-level, and 0.2% (1) of the patients underwent a three-level procedure. 83.6% (417) of the patients in this study underwent a primary LD and 14.0% (70) underwent a revision decompression.\n\n\nCONCLUSION\nThis is the largest clinical case series focused on lumbar decompression procedures within an ASC requiring no planned 23-hour observation. This study demonstrates the feasibility of performing lumbar decompression surgery in an ASC with proper patient selection, surgical technique and MMA protocol. All patients were discharged from the surgical center on the same day of surgery.