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Protocolization of Post-Transforaminal Lumbar Interbody Fusion Pain Control with Elimination of Benzodiazepines and Long-Acting Opioids
- Source :
- Neurosurgery. 86:717-723
- Publication Year :
- 2019
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2019.
-
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.
- Subjects :
- Adult
Male
medicine.drug_class
Nonbenzodiazepine
01 natural sciences
Cohort Studies
Benzodiazepines
03 medical and health sciences
0302 clinical medicine
medicine
Humans
Pain Management
030212 general & internal medicine
0101 mathematics
Retrospective Studies
Pain, Postoperative
Benzodiazepine
Lumbar Vertebrae
business.industry
010102 general mathematics
Retrospective cohort study
Analgesics, Non-Narcotic
Middle Aged
Hydromorphone
Acetaminophen
Analgesics, Opioid
Spinal Fusion
Opioid
Anesthesia
Cohort
Female
Surgery
Neurology (clinical)
business
Low Back Pain
Oxycodone
medicine.drug
Subjects
Details
- ISSN :
- 15244040 and 0148396X
- Volume :
- 86
- Database :
- OpenAIRE
- Journal :
- Neurosurgery
- Accession number :
- edsair.doi.dedup.....1d13ba7859875691a1ac945d327fc0c5