Abstract
Abstract
INTRODUCTION
The United States opioid epidemic continues to impact the lives and health of American citizens. Many opioid-naive patients are first exposed to these medications following major surgery. Here, we describe patients' postoperative self-reported pain scores and consumption of opioids and associated as-need medications following minimally invasive surgery (MIS) in an Enhanced Recovery After Surgery® (ERAS) paradigm.
METHODS
We reviewed patients with 1- or 2-level degenerative lumbar spine disease who underwent an endoscopic transforaminal lumbar interbody fusion (TLIF) with local long-acting depoform bupivacaine, or conventional MIS TLIF. Patients' self-reported postoperative pain scores and in-hospital consumption of opioids (converted to morphine equivalent, MME) and associated as-needed medications were collected and compared between groups.
RESULTS
A consecutive series of 50 patients who underwent ERAS® TLIF (ERAS group) were compared to a series of 50 patients who underwent conventional MIS TLIF (MIS group). Demographics and preoperative functional status were similar between groups. As the average length of hospital stay was only 23 h in the ERAS group, meaningful comparisons were only possible for postoperative days 0 and 1. Patients in the ERAS group reported significantly less postoperative pain during the entire in-hospital period (2.3 ± 2.1 vs 2.4 ± 1.9, P < .01). Average daily pain scores were also reduced in the ERAS group. The average total postoperative opioid dosage was significantly reduced in the ERAS group compared to the MIS group (64.1 ± 77.9 MME vs 194.6 ± 153.4 MME, P < .01). Average daily opioid consumption was also reduced in the ERAS group. During the entire postoperative period, the ERAS group consumed less as-needed diphenhydramine (1.5 ± 7.8 vs 17.6 ± 42.8, P = .030), pantoprazole (38.8 ± 69.8 mg vs 85.4 ± 102.1 mg, P = .020), and docusate (222.0 ± 299.9 mg vs 650.0 ± 417.1 mg, P < .01).
CONCLUSION
This study demonstrates a significant decline in self-reported pain, narcotic consumption, symptomatic medication administration with MIS TLIF in an ERAS® paradigm.
