Publication date: Jan 08, 2020
To evaluate pain management following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and Scheuermann’s Kyphosis (SK) determine the optimal opioid and benzodiazepine prescription amounts, and implement a multimodal post-operative pain regimen. The incidence of prescription opioid abuse is increasing in the United States. Orthopedic spine surgeons often prescribe large quantities of opioids post-operatively for pain control. Previous efforts on pain control have focused on in-patient post-operative regimens after PSF.
Between 2/1/17 and 5/30/18 patients with AIS or SK were sent home with pain diaries after discharge to document daily narcotic, benzodiazepine, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen and gabapentin use following PSF. Diaries were collected at the 4 week post-operative visit. Data from two cohorts were reviewed: pre-intervention and post-intervention. Our prescription intervention went into effect 9/1/17.
Twenty-four (30%) patients returned pain diaries. The pre-intervention cohort consisted of 12 patients (7 female; 5 males; 14.9 years (range 12-19)). Patients were prescribed on average 80?x?5 mg tabs (26-140) of oxycodone but used on average 45 tabs (12-129) over an average of 17.5 days (9-33). They were prescribed an average of 30?x?2 mg tabs (0-150) of diazepam, used on average 4.8 (0-105) tabs over 12.5 (5-25) days. The post-intervention cohort consists of 12 patients (9 female; 3 male; 14.8 years (12-19)). They were prescribed on average 50?x?5 mg tabs (35-80) of oxycodone, used 20.5 (0-39.5) tabs over 8.5 days (3-16). They were prescribed on average 18?x?2 mg tabs of diazepam (0-43), used 5.4 tabs (0-19) over 10 days (5-14).
This analysis has directly impacted clinical practice. Prescribed opioid and benzodiazepine doses have been decreased by over 50%, and more resources are being directed towards determining the disparity between the amount of medications prescribed and consumed in our post-operative patients.
Lindgren, A.M., Bennett, R., Yaszay, B., Newton, P.O., and Upasani, V.V. Quality improvement in post-operative opioid and benzodiazepine regimen in adolescent patients after posterior spinal fusion. 04489. 2020 Spine Deform.
- Investigating Interventions to Reduce Residual Opioids in the Home Following Legitimate Opioid Prescribing in Children.
- ERP and Multimodal Pain Management
- To Fight Opioid Misuse and Dependence, Assume Every Patient is At Risk
- Opioid Clinical Practice Guidelines Implementation Workshop Part 1 of 2 (2018)