Spinal Anesthesia for Spine Surgery Reduces Perioperative Medication Use in Older Adults

The use of spinal anesthesia (SA) reduced perioperative polypharmacy and opioid administration among older adults undergoing transforaminal lumbar interbody fusion (TLIF) when compared with the use of general anesthesia (GA), according to the results of a recent study presented at the American Association of Neurological Surgeons 2024 Annual Scientific Meeting.

Two adverse effects of spine surgery in elderly patients, postoperative cognitive dysfunction (POCD) and delirium, are thought to be associated with perioperative polypharmacy and opioid use. In this retrospective analysis, researchers examined how the type of anesthesia administered during spine surgery impacted the perioperative use of medication in this patient population. 

Included were adults aged 65 years or older who underwent TLIF by a single surgeon at a single academic center from 2014 to 2021. Of the 200 total patients, 120 underwent SA while 80 underwent GA. Morphine milligram equivalents (MME) were used to quantify opioid consumption. Demographic, procedural, and medication data were extracted from the medical records.

The results indicated that patients given SA had an average of 7.45 medications administered vs 12.7 for patients who were given GA (p < .001). Further, the average perioperative opioid consumption was 5.17 MME and 20.2 MME, respectively (p < .001).

The use of antiemetics and opioids remained comparable postoperatively, at a mean of 32.2 MME and 27.5 MME, respectively (p = .14). The SA group had less frequent use of an antiemetic as a prophylactic (32%) vs the GA group (86%).

“Spinal anesthesia reduces perioperative polypharmacy in patients ≥65 years undergoing TLIF procedures,” the researchers concluded. “Further research is necessary to determine if this reduction correlates to a decrease in the incidence of POCD and delirium.”

Reference:

Karimi H, Hernandez NS, Kanter M, et al. Spinal anesthesia reduced perioperative polypharmacy and opioid burden in patients over 65 who undergo lumbar spine surgery. Presented at: American Association of Neurological Surgeons Annual Scientific Meeting; May 3-6, 2024; Chicago, IL. https://annualmeeting.aans.org/