Opioid-sparing anesthesia in adult spinal deformity surgery may reduce opioid consumption
CHICAGO — Results showed opioid-sparing anesthesia in adult spinal deformity surgery reduced total opioid consumption and opioid-related complications, as well as the need for the ICU, blood transfusion, pain scores and length of stay.
“Overall, it is important to utilize alternative techniques and medications undergoing [adult spinal deformity] ASD surgery, or any spinal surgery, in order to minimize opioid consumption, especially because of the invasiveness of these types of surgeries,” Jeffrey L. Gum, MD, said in his presentation at the North American Spine Society Annual Meeting.
Gum and colleagues propensity matched 43 patients with ASD undergoing greater than five-level spinal fusion who received an opioid-sparing anesthesia to 43 patients with ASD who received traditional anesthesia based on sex, smoking, BMI, American Society of Anesthesiologists score, insurance status, levels fused, revision vs. primary surgery and surgical invasiveness.
“We know that there is a massive difference in deformity surgery, so we wanted to compare apples to apples and we used a validated surgical invasiveness score so we could match patients based on that, as well,” Gum said.
Researchers considered in-hospital opioid consumption as the primary outcome and evaluated opioid-related complications, emergence time, post-anesthesia care unit (PACU) time, pain score on transfer in and transfer out of PACU, hospital length of stay and ICU admission.
Gum noted patients in the opioid-sparing anesthesia group had lower pain in and out of the PACU, shorter length of stay, fewer ICU admissions and lower blood transfusion rates. Results also showed patients in the opioid-sparing anesthesia group had reduced opioid consumption intraoperatively and on postoperative day 1 and decreased total consumption on each postoperative day compared with the traditional anesthesia group.
“Overall, we reduced opioid consumption for the index hospital stay by 47%,” Gum said. “If you look at opioid-related complications, there was a difference with regard to opioid-related constipation, ileus and urinary retention.”
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Gum JL, et al. Paper 175. Presented at: North American Spine Society Annual Meeting; Oct. 12-15, 2022; Chicago.
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