Nguyen Anthony V, Soto Jose M, Keith Kristin A, Lyon Kristopher A, Rahm Mark D, Huang Jason H
Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, 76508, USA.
Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, 76508, USA.
Spine J. 2025 May;25(5):974-982. doi: 10.1016/j.spinee.2024.11.021. Epub 2024 Dec 9.
Ropivacaine-Epinephrine-Clonidine-Ketorolac (RECK) cocktail can improve pain control in patients undergoing lumbar decompression. Given the aging population, rising healthcare costs, the opioid epidemic, and associations of acute pain control with long-term opioid use, effective opioid-sparing analgesia following spinal fusion surgery may impart societal benefits.
We aimed to investigate whether RECK was an effective local anesthetic for patients undergoing posterior spinal fusion.
STUDY DESIGN/SETTING: Single-center retrospective cohort study.
Patients who underwent posterior spinal fusion surgery from June 2019 to June 2021.
Primary outcomes of interest were postoperative pain levels as determined by Visual Analog Scale, in-hospital opioid consumption, length-of-stay <4 days, and long-term opioid utilization at three months postoperatively. Secondary outcomes of interest were rates of discharge to home, complication rates, readmissions within 90 days.
We analyzed whether opioid exposure, patient-specific or surgery-specific factors, and administration of RECK (versus another local anesthetic) were associated with postoperative pain levels, in-hospital opioid consumption, length-of-stay, home discharge, long-term opioid utilization, complications, and readmissions within 90 days using multivariable regression.
Of the 162 patients meeting study criteria, 49 (30.2%) received RECK. RECK was significantly associated with decreased pain levels at 2-, 4-, 6-, and 12-hours postoperatively (p≤.001-.01). RECK was associated with decreased total and daily inpatient opioid utilization (as measured by oral morphine equivalents) in multivariable linear regression (B=-159.6, 95% CI:-255.5- -63.6, p=.002 and B=-27.9, 95% CI:-48.9- -7.0, p=.01, respectively). Length-of-stay duration of <4 days was associated with RECK administration (OR 4.1, 95% CI:1.4-13.2, p=.01) and was negatively associated with levels fused (OR 0.4, 95% CI:0.2-0.7, p=.005) and durotomy (OR 0.02, 95% CI:0.0009-0.1, p<.001). Prolonged postoperative opioid utilization was associated with preoperative opioid prescription (OR 3.6, 95% CI:1.7-7.8, p=.001) and was negatively associated with RECK (OR 0.4, 95% CI:0.2-0.9, p=.04). RECK was not associated with readmissions, complications, or home discharge.
In patients undergoing posterior spinal fusion, RECK was superior to other local anesthetics as it improved pain control, decreased length-of-stay, and decreased opioid utilization. RECK was not associated with increased complications, readmissions, or rates of discharge to home.
罗哌卡因 - 肾上腺素 - 可乐定 - 酮咯酸（RECK）鸡尾酒可改善接受腰椎减压患者的疼痛控制。鉴于人口老龄化、医疗成本上升、阿片类药物流行以及急性疼痛控制与长期使用阿片类药物的关联，脊柱融合手术后有效的阿片类药物节省镇痛可能具有社会效益。
我们旨在研究RECK对接受后路脊柱融合术的患者是否为一种有效的局部麻醉剂。
研究设计/地点：单中心回顾性队列研究。
2019年6月至2021年6月接受后路脊柱融合手术的患者。
主要观察指标包括通过视觉模拟量表确定的术后疼痛水平、住院期间阿片类药物消耗量、住院时间<4天以及术后三个月的长期阿片类药物使用情况。次要观察指标包括回家出院率、并发症发生率、90天内再入院率。
我们使用多变量回归分析阿片类药物暴露、患者特异性或手术特异性因素以及RECK的给药（与另一种局部麻醉剂相比）是否与术后疼痛水平、住院期间阿片类药物消耗量、住院时间、回家出院、长期阿片类药物使用、并发症以及90天内再入院相关。
在符合研究标准的162例患者中，49例（30.2%）接受了RECK。RECK与术后2小时、4小时、6小时和12小时疼痛水平降低显著相关（p≤0.001 - 0.01）。在多变量线性回归中，RECK与住院期间阿片类药物总消耗量和每日消耗量降低相关（以口服吗啡当量衡量）（B = -159.6，95%CI：-255.5 - -63.6，p = 0.002和B = -27.9，95%CI：-48.9 - -7.0，p = 0.01）。住院时间<4天与RECK给药相关（OR 4.1，95%CI：1.4 - 13.2，p = 0.01），与融合节段数呈负相关（OR 0.4，95%CI：0.2 - 0.7，p = 0.005），与硬脊膜切开术呈负相关（OR 0.02，95%CI：0.0009 - 0.1，p < 0.001）。术后长期阿片类药物使用与术前阿片类药物处方相关（OR 3.6，95%CI：1.7 - 7.8，p = 0.001），与RECK呈负相关（OR 0.4，95%CI：0.2 - 0.9，p = 0.04）。RECK与再入院、并发症或回家出院无关。
在接受后路脊柱融合术的患者中，RECK优于其他局部麻醉剂，因为它改善了疼痛控制，缩短了住院时间，并减少了阿片类药物的使用。RECK与并发症增加、再入院或回家出院率无关。
