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

STUDY

DESIGN

This study was a retrospective propensity-matched study of patients receiving opioid-sparing anesthesia (OSA) and those who did not receive an opioid-sparing anesthesia regimen.

OBJECTIVES

To determine whether patients undergoing spine fusion for deformity fared better with an OSA regimen than those not having an OSA regimen.

SUMMARY OF BACKGROUND DATA: There has been a tremendous focus on opioid overuse. Accordingly, OSA regimens are being introduced to reduce narcotic use. However, OSA has not been studied in the adult spine deformity population.

METHODS

Forty-three patients undergoing fusion of at least five levels in the thoracolumbar spine received OSA. They were matched to 43 patients who did receive an OSA regimen. We analyzed several metrics including blood loss, anesthesia time, postanesthesia care unit (PACU) pain scores, postoperative pain scores, complications, length of stay, and readmissions.

RESULTS

The OSA group had significantly lower pain scores both before transfer to (4.6 vs . 7.6, P =0.000) and after transfer from (4.2 vs . 6.2 P =0.002) the PACU. Opioid use was significantly lower in the OSA group (454 vs . 241 MMEs by POD4, P =0.022). Fewer patients required blood transfusion in the OSA (1 vs . 28, P =0.000) group. Fewer patients in the OSA group had constipation and urinary retention (1 vs . 9, P =0.015). There was no difference in discharge home or to a facility. The lengths of hospital (4.33 vs . 6.19, P =0.009) and ICU (0.12 vs . 0.70 d, P =0.009) stays were significantly shorter in the OSA group.

CONCLUSIONS

OSA regimens have numerous benefits in patients undergoing spinal deformity surgery, including less opioid use, fewer postoperative complications, and a reduced length of stay.