Delirium Bibliography

Reference Information

Title

Spinal Anesthesia Reduces Perioperative Polypharmacy and Opioid Burden in Patients Over 65 Who Undergo Transforaminal Lumbar Interbody Fusion

Authors

Karimi, H. Patel, J. Olmos, M. Kanter, M. Hernandez, N. S. Silver, R. E. Liu, P. Riesenburger, R. I. Kryzanski, J.

Year

2024

Journal

World Neurosurg

Abstract

BACKGROUND: Polypharmacy and opioid administration are thought to increase the risk of postoperative cognitive dysfunction 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. We aim to 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 χ(2) 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). CONCLUSIONS: SA 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 postoperative cognitive dysfunction and delirium.

PMID

PMID: 38432509

 

Keywords

Humans
*Spinal Fusion/methods
*Analgesics, Opioid/therapeutic use/administration & dosage
Aged
Male
Female
*Polypharmacy
Retrospective Studies
*Anesthesia, Spinal/methods
*Lumbar Vertebrae/surgery
Aged, 80 and over
Anesthesia, General/methods
Pain, Postoperative/drug therapy/prevention & control
Geriatrics
Lumbar surgery
Polypharmacy
Postoperative cognitive dysfunction
Spinal anesthesia

Page(s)

Volume

Issue