Enhanced Recovery After Surgery Protocol for Lumbar Spinal Surgery With Regional Anesthesia: A Retrospective Review

Area of Science:

• Anesthesiology
• Surgical Outcomes
• Pain Management

Background:

• Spinal fusion surgery in the USA has the highest hospital costs.
• Enhanced recovery after surgery (ERAS) protocols are increasingly used, but their impact on perioperative outcomes in spinal surgery is not fully understood.
• Quality improvement initiatives are crucial for optimizing surgical pathways.

Purpose of the Study:

• To evaluate the efficacy of an ERAS protocol combined with an intraoperative modified thoracolumbar interfascial plane (mTLIP) block.
• To determine if these interventions reduce postoperative length of stay (LOS) and opioid requirements.
• To analyze outcomes in patients undergoing elective lumbar spinal fusion or laminectomy.

Main Methods:

• Retrospective review of adult patients undergoing elective lumbar spinal fusion or laminectomy.
• Implementation of an ERAS protocol including preoperative gabapentin and acetaminophen, intraoperative mTLIP block with liposomal bupivacaine, and intraoperative/postoperative ketamine, ketorolac, and tranexamic acid.
• Comparison of outcomes (LOS, opioid use, readmissions, morbidity) between ERAS treatment groups and historical controls.

Main Results:

• For laminectomy patients, the ERAS group showed a 51.42% reduction in opioid requirement (P=0.03) and a 2.04-day reduction in LOS (P=0.01).
• For spinal fusion patients, the ERAS group demonstrated a 38.33% reduction in opioid requirement (P=0.04), with no significant difference in LOS.
• No significant differences in 90-day readmissions or morbidity were detailed in the abstract.

Conclusions:

• The ERAS protocol, incorporating regional anesthesia via mTLIP block, significantly reduces length of stay for lumbar laminectomy.
• This combined approach leads to a significant reduction in opioid administration for both lumbar laminectomies and spinal fusion surgeries.
• ERAS protocols represent a valuable strategy for improving perioperative outcomes in elective lumbar spine surgery.