23 - Opioid Sparing Anesthesia for Adult Spinal Deformity Surgery Reduces Postoperative Pain, Length of Stay, ICU Stay, Opioid Consumption, and Opioid-Related Complications: A Propensity Matched Analysis

Friday, June 2, 2023

10:38 AM – 10:42 AM

Location: Salons 13-15

Co-Author(s)

JG

Jeffrey L. Gum, MD

Adult and Pediatric Spine Surgeon
Norton Leatherman Spine
Louisville, Kentucky, United States

Co-Author(s)

LC

Leah Carreon, n/a

Clinical Research Director
Norton Leatherman Spine Center, United States
BS

Benjamin Sampedro

United States
JH

Jennifer Harpe-Bates

United States
BH

Bren Hines

United States
MB

Morgan Brown

United States
CD

Christy Daniels

United States
NW

Neil Werthmann

United States
Steven D. Glassman, MD

Medical Director
Norton Leatherman Spine Center
Louisville, Kentucky, United States

Submitter(s)

LC

Leah Carreon, n/a

Clinical Research Director
Norton Leatherman Spine Center, United States

Presenting Author (Person doing the Podium Present(s)

CC

Charles H. Crawford, MD

Spine Surgeon
Norton Leatherman Spine Center, United States

Disclosure(s):

Charles H. Crawford, MD: No relevant disclosure to display

Introduction: The US opioid crisis highlights the dire need to reduce opioid exposure with alternative approaches. Prior studies report that 25% of opioid naive patients are still on opioids two years after spinal fusion surgery. Currently, opioids are a primary component of anesthesia during spinal surgery. We developed an opioid sparing anesthesia (OSA) protocol for adult spinal deformity (ASD) surgery to mitigate opioid exposure.

Objective: To determine if reducing intraoperative opioid consumption improves postoperative recovery kinetics.

Methods: Opioid naive patients undergoing > 5 level lumbar fusion for were identified. Patients receiving OSA were propensity-matched to non-OSA patients based on sex, smoking status, BMI, ASA grade, surgical invasiveness, number of levels fused, and revision vs primary procedure. The OSA protocol includes a combination of IV propofol, lidocaine, ketamine, magnesium, dexmedetomidine, and esmolol as needed. A standard opioid escalation protocol was used postoperatively.

Results: Of 45 OSA patients meeting inclusion criteria, 43 were successfully propensity matched to 43 non-OSA patients. There were no differences in baseline demographic or surgical parameters. Opioid consumption was reduced intraoperatively (3.6 vs 53.2MME, p=0.000), on POD 1 (67.4 vs 111.6MME, p=0.030), and each POD with decreased total consumption (241.3 vs 453.9MME, p=0.022). OSA patients had reduced opioid-related complications (1 vs 9, p=0.015) and less patients required blood transfusion (1 vs 28, p=0.000) despite similar EBL (570 vs 692cc, p=0.294). Emergence time (17.4 vs 14.3min, p=0.374) and PACU time (113.8 vs 142.6min, p=0.077) was similar between cohorts. There was a shorter LOS for OSA patients (4.3 vs 6.2 days, p=0.009) and less ICU admissions (4 vs 14, p=0.015). Pain score on transfer in (4.6 vs 7.6, p=0.000) and out (4.2 vs 6.2, p=0.002) of PACU was lower for OSA patients as well.

Conclusion: Our results show that OSA in ASD surgery improves immediate postoperative recovery kinetics by reducing the need for ICU, blood transfusion, pain scores, and LOS. Opioid-related complications and total opioid consumption were reduced as well. OSA appears to be an attractive alternative to opioid-dependent anesthesia protocols in ASD surgery.