Protocolization of Post-Transforaminal Lumbar Interbody Fusion Pain Control with Elimination of Benzodiazepines and Long-Acting Opioids. Issue 5 (5th July 2019)

• Record Type: Journal Article
• Authors: Boulter, Jason H; Curry, Brian P; Szuflita, Nicholas S; Miller, Charles A; Spinelli, Joseph; Delaney, John J; Neal, Chris J; Spevak, Christopher J; Bell, Randy S
• Is Part Of: Neurosurgery. Volume 86:Issue 5(2020)
• Page Start: 717
• Page End: 723
• Publication Date: 2019-07-05
• Subjects: Opioids -- Pain control -- Spinal fusion -- Quality improvement; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyz232
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: The opioid epidemic continues to worsen with a concomitant increase in opioid-related mortality. In response, the Department of Defense and Veterans Health Agency recommended against the use of long-acting opioids (LAOs) and concurrent use of opioids with benzodiazepines. Subsequently, we eliminated benzodiazepines and LAOs from our postoperative pain control regimen. OBJECTIVE: To evaluate the impact of removing benzodiazepines and LAOs on postoperative pain in single-level transforaminal lumbar interbody fusion (TLIF) patients. METHODS: A retrospective cohort study of single-level TLIF patients from February 2016-March 2018 was performed. Postoperative pain control in the + benzodiazepine cohort included scheduled diazepam with or without LAOs. These medications were replaced with nonbenzodiazepine, opioid-sparing adjuncts in the −benzodiazepine cohort. Pain scores, length of hospitalization, trigger medication use, and opioid use and duration were compared. RESULTS: Among 77 patients, there was no difference between inpatient pain scores, but the -benzodiazepine cohort experienced a faster rate of morphine equivalent reduction (−18.7%, 95% CI [−1.22%, −36.10%]), used less trigger medications (−1.55, 95% CI [−0.43, −2.67]), and discharged earlier (0.6 d; 95% CI [0.01, 1.11 d]). As outpatients, the −benzodiazepine cohort was less likely to receive opioid refills at 2 wk (29.2% vs 55.8%, P = .021) and 6 mo postoperatively (0% vs 13.2%, P = .039), and was less likely to be using opioids by 3 mo postoperatively (13.3% vs 34.2%, P = .048). CONCLUSION: Replacement of benzodiazepines and LAOs in the pain control regimen for single-level TLIFs did not affect pain scores and was associated with decreased opioid use, a reduction in trigger medications, and shorter hospitalizations. Graphical Abstract: