Enhanced recovery after posterior cervical fusion surgery: A retrospective case series

Curley, Kara L.; Richards, Alexandra E.; Zhang, Nan; Lyons, Mark; Neal, Matthew T.

doi:10.1016/j.inat.2021.101143

Cited by 4 publications

(6 citation statements)

References 21 publications

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Section: Discussionmentioning

confidence: 99%

“…This investigation is the first to examine the effects of LB on post-operative opioid consumption in patients undergoing primary ACDF, although there have been similar studies addressing LB in other types of spinal surgery ( 21 , 27 - 31 ). For example, LB has been included as a component of enhanced recovery after surgery (ERAS) protocols in posterior cervical surgery ( 27 ). A retrospective case series of 99 patients who underwent posterior cervical decompression and fusion showed that an ERAS protocol including intraoperative intramuscular LB did not shorten LOS or improve discharge disposition compared to a non-ERAS protocol without LB ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

“…For example, LB has been included as a component of enhanced recovery after surgery (ERAS) protocols in posterior cervical surgery ( 27 ). A retrospective case series of 99 patients who underwent posterior cervical decompression and fusion showed that an ERAS protocol including intraoperative intramuscular LB did not shorten LOS or improve discharge disposition compared to a non-ERAS protocol without LB ( 27 ). Results comparable to those in the present study regarding the effectiveness of LB can also be found elsewhere in spine literature.…”

Section: Discussionmentioning

confidence: 99%

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Liposomal bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior cervical discectomy and fusion

Neufeld¹,

Ng²,

Schaffler³

et al. 2022

J Spine Surg

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Background Despite its widespread use, definitive data demonstrating the efficacy of liposomal bupivacaine (LB) is limited especially in patients undergoing anterior cervical discectomy and fusion (ACDF). Therefore, this investigation examined whether ACDF patients who received intra-operative LB (LB cohort) exhibited decreased post-operative opioid use and lengths of hospital stay (LOS) compared to ACDF patients who did not receive intra-operative LB (controls). Methods Eighty-two patients who underwent primary ACDF by a single surgeon from 2016 to 2019 were identified from an institutional database. Fifty-nine patients received intra-operative LB while twenty-three did not. Patient characteristics, medical comorbidities, complications, post-operative opioid consumption, and LOS data were collected. Results The LB cohort did not require fewer opioids on post-operative day (POD) 0, POD1, POD2, or throughout the hospital course after normalizing by LOS (total per LOS). The number of cervical vertebrae involved in surgery, but not LB use, predicted opioid consumption on POD0, POD1, and total per LOS. For every vertebral level involved, 242 additional morphine milligram equivalents (MME) were consumed on POD0, 266 additional MME were utilized on POD1, and 130 additional MME were consumed in total per LOS. Conclusions ACDF patients who received intra-operative LB did not require fewer post-operative opioids or exhibit a decreased LOS compared to controls. Patients whose procedures involved a greater number of cervical vertebrae were associated with greater opioid consumption on POD0, POD1, and total per LOS. ACDF patients, especially those who had a high number of vertebrae involved, may require alternative analgesia to LB.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Liposomal bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior cervical discectomy and fusion

Neufeld¹,

Ng²,

Schaffler³

et al. 2022

J Spine Surg

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“…The review further excluded the following: articles that did not address pain management, ERAS, or perioperative settings; studies on specific pain modalities; studies on pediatric patients; evaluation tool interventions; interventions after discharge; and preliminary trials. After screening for duplicate articles and reviewing all titles, 31 eligible articles remained 13‐43 …”

Section: Accessing the Literaturementioning

confidence: 99%

“…In response to variations in current pain management practices, endorsement of standardized anesthesia and analgesia is repeatedly echoed in the recent literature 13‐31 . The ERAS pain management strategies aimed to optimize patients’ health status and addressed the themes of procedural‐specificity, 13,14,16,18,21,22,24,26,28‐32,34,36‐39,43 opioid‐sparing, 13‐15,16‐18,21‐24,26‐39,43 and multimodal analgesia 13‐15,16‐18,21‐24,26‐35,37‐39,43 . To address these themes, health care professionals can implement a synergistic pain management approach tailored to the procedure being performed that may involve administration of medications and use of techniques to target pain receptors.…”

Section: Appraising the Literaturementioning

confidence: 99%

The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii

Doronio,

Lee

2023

AORN Journal

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Traditional use of opioids to treat postoperative pain may lead to abuse and overdose. The development of Enhanced Recovery After Surgery (ERAS) protocols has helped to shift pain management from traditional methods to evidence‐based best practices involving multimodal analgesia techniques. The purpose of this quality improvement project was to implement and determine the effectiveness of a standardized, evidence‐based ERAS pain management pathway for patients undergoing colorectal or gynecology procedures at a medical center in Hawaii. After the intervention, the evaluation of data associated with opioid use, patients’ pain scores, time spent in the postanesthesia care unit, and inpatient length of stay showed that most results were not significant. However, the ERAS pain management pathway did reduce clinical practice variations, intraoperative opioid administration, the time that patients spent in the postanesthesia care unit, and length of stay. The ERAS pain management pathway continues to be used and updated at this facility.

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The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis

Lele,

Moreton,

Mejia-Mantilla

et al. 2024

Journal of Neurosurgical Anesthesiology

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In this review article, we explore the implementation and outcomes of enhanced recovery after spine surgery (spine ERAS) across different World Bank country-income levels. A systematic literature search was conducted through PubMed, Embase, Scopus, and CINAHL databases for articles on the implementation of spine ERAS in both adult and pediatric populations. Study characteristics, ERAS elements, and outcomes were analyzed and meta-analyses were performed for length of stay (LOS) and cost outcomes. The number of spine ERAS studies from low-middle-income countries (LMICs) increased since 2017, when the first spine ERAS implementation study was published. LMICs were more likely than high-income countries (HICs) to conduct studies on patients aged ≥18 years (odds ratio [OR], 6.00; 95% CI, 1.58-42.80), with sample sizes 51 to 100 (OR, 4.50; 95% CI, 1.21-22.90), and randomized controlled trials (OR, 7.25; 95% CI, 1.77-53.50). Preoperative optimization was more frequently implemented in LMICs than in HICs (OR, 2.14; 95% CI, 1.06-4.41), and operation time was more often studied in LMICs (OR 3.78; 95% CI, 1.77-8.35). Implementation of spine ERAS resulted in reductions in LOS in both LMIC (−2.06; 95% CI, −2.47 to −1.64 d) and HIC (−0.99; 95% CI, −1.28 to −0.70 d) hospitals. However, spine ERAS implementation did result in a significant reduction in costs. This review highlights the global landscape of ERAS implementation in spine surgery, demonstrating its effectiveness in reducing LOS across diverse settings. Further research with standardized reporting of ERAS elements and outcomes is warranted to explore the impact of spine ERAS on cost-effectiveness and other patient-centered outcomes.

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Enhanced recovery after posterior cervical fusion surgery: A retrospective case series

Cited by 4 publications

References 21 publications

Liposomal bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior cervical discectomy and fusion

Liposomal bupivacaine does not decrease postoperative opioid use or length of hospital stay in patients undergoing anterior cervical discectomy and fusion

The Effect of Implementing a Standardized Enhanced Recovery After Surgery Pain Management Pathway at an Urban Medical Center in Hawaii

The Implementation of Enhanced Recovery After Spine Surgery in High and Low/Middle-income Countries: A Systematic Review and Meta-Analysis

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