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Spinal anesthesia reduces perioperative polypharmacy and opioid burden in patients over 65 who undergo Transforaminal Lumbar Interbody Fusion – Lumbar Fusion

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The article explores the impact of spinal anesthesia (SA) on perioperative polypharmacy and opioid administration in elderly patients undergoing transforaminal lumbar interbody fusion (TLIF) surgery. A retrospective analysis of 200 patients revealed that those who received SA had significantly lower medication administration and opioid consumption compared to those who underwent general anesthesia (GA). The study suggests that SA may be beneficial in reducing polypharmacy in older patients during spine surgery, potentially leading to a decrease in postoperative cognitive dysfunction (POCD) and delirium. Further research is needed to confirm these findings and explore the clinical implications

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

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

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World Neurosurg. 2024 Mar 1:S1878-8750(24)00340-1. doi: 10.1016/j.wneu.2024.02.127. Online ahead of print.ABSTRACTBACKGROUND: Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction (POCD) and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce,

World Neurosurg. 2024 Mar 1:S1878-8750(24)00340-1. doi: 10.1016/j.wneu.2024.02.127. Online ahead of print.

ABSTRACT

BACKGROUND: Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction (POCD) and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce polypharmacy and opioid administration is warranted.

AIMS: Compare the perioperative polypharmacy and dose of administered opioids in patients ≥65 years who undergo transforaminal lumbar interbody fusion (TLIF) under SA versus general anesthesia (GA).

METHODS: A retrospective analysis of 200 patients receiving a single-surgeon TLIF procedure at a single academic center (2014-2021) was performed. Patients underwent the procedure with SA (n =120) or GA (n=80). Demographic, procedural, and medication data were extracted from the medical record. Opioid consumption was quantified as morphine milligram equivalents (MME). Statistical analyses included Chi-square or Student’s t-test.

RESULTS: Patients receiving SA were administered 7.45 medications on average versus 12.7 for GA patients (p<0.001). Average perioperative opioid consumption was 5.17 MME and 20.2 MME in SA and GA patients, respectively (p<0.001). The number of patients receiving antiemetics and opioids remained comparable postoperatively, with a mean of 32.2 MME in the GA group versus 27.5 MME in the SA group (p=0.14). Antiemetics were administered less often as a prophylactic in the SA group (32%) versus 86% in the GA group (p<0.001).

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

PMID:38432509 | DOI:10.1016/j.wneu.2024.02.127

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Spinal anesthesia reduces perioperative polypharmacy and opioid burden in patients over 65 who undergo Transforaminal Lumbar Interbody Fusion

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World Neurosurg. 2024 Mar 1:S1878-8750(24)00340-1. doi: 10.1016/j.wneu.2024.02.127. Online ahead of print.ABSTRACTBACKGROUND: Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction (POCD) and delirium in elderly patients. Spinal anesthesia (SA) holds potential to reduce perioperative polypharmacy in spine surgery. As more geriatric patients undergo spine surgery, understanding how SA can reduce

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