Using an Enhanced Recovery After Surgery (ERAS) guided Multimodal Pathway to Reduce Opioid Consumption in Lumbar Spine Surgery

Abstract

Abstract Background: Spinal pathologies are increasingly prevalent among the aging population in the United States, leading to back pain as a common reason for adults seeking emergency care and necessitating surgical interventions. Lumbar and spinal fusions have been associated with high rates of opioid use, contributing to the opioid public health crisis. Enhanced Recovery After Surgery (ERAS) protocols have successfully reduced complications and hospital length of stay (LOS) across various surgical specialties, but their potential in spine surgery remains unexplored. The primary aim of this quality improvement project was to assess the impact of an ERAS multimodal pathway on opioid consumption rates in patients undergoing lumbar spine surgery. Methods: Patients undergoing lumbar spine surgery were included between August 30 and September 30, 2017 (PRE-ERAS Group n=12) and August 30 and September 30, 2018 (POST-ERAS Group n=13). Before the implementation of ERAS, there was no consistent use of multimodal pain modalities. The new ERAS multimodal pathway included non-opioid medications such as Acetaminophen, NSAIDs, gabapentinoids, and local anesthetics. Data were collected from electronic medical records, including demographics, intraoperative opioids, PACU LOS, pain scores, and opioid consumption in the recovery room until discharge. Results: Implementing an ERAS multimodal pathway was associated with significantly lower postoperative pain scores (p = .003) and a trend towards decreased patient opioid administration dosages(p=.22). Post-operative nausea and vomiting (PONV) scores were zero in both PRE- and POST-ERAS groups, while postoperative LOS increased (p=.02) in the POST-ERAS group. Conclusion: Implementing an ERAS multimodal pathway is associated with improved pain scores and may reduce opioid consumption in elective lumbar spine surgery.