Enhanced Recovery Pathway Reduced Opioid Use and Pain Scores in Elective Spine Surgery

Area of Science:

• Orthopaedic Surgery
• Pain Management
• Clinical Pathways

Background:

• Enhanced Recovery Pathways (ERP) are multimodal protocols designed to optimize surgical patient recovery.
• The application of ERPs in elective spine surgery requires further investigation regarding their impact on pain and opioid consumption.

Purpose of the Study:

• To evaluate the effectiveness of an enhanced recovery pathway (ERP) in reducing opioid utilization and pain severity following elective spine surgery.
• To compare outcomes between patients managed with a novel ERP and a historical control group.

Main Methods:

• A historical cohort study included 171 patients undergoing elective spine surgery from 2017 to 2021.
• 92 patients received the ERP between 2019-2021, compared to 79 historical controls (2017-2019).
• Primary outcomes measured were opioid use (milligram morphine equivalents) and average daily pain scores.

Main Results:

• The ERP group demonstrated significant reductions in opioid use on postoperative days 1-3 (36-37% decrease, p < 0.005).
• Patients in the ERP group reported lower average pain scores on postoperative days 1-3 (1.0-1.5 points lower, p < 0.005).
• Length of stay was comparable between the ERP and control groups (4.3 vs. 4.5 days, p = 0.693).

Conclusions:

• Implementation of this enhanced recovery pathway is associated with clinically meaningful reductions in opioid consumption and pain after elective spine surgery.
• ERPs represent a valuable strategy for improving postoperative pain management and reducing opioid dependence in spine surgery patients.
• Further research can explore long-term benefits and broader applicability of ERPs in spinal procedures.