Evaluation of an opioid-sparing protocol for spine surgeries performed in an ambulatory surgery center

BACKGROUND Data on opioid-sparing spine surgery is mostly limited to the hospital setting with a focus on perioperative outcomes. There is even less data available on ideal pain management approaches for spine surgery patients in an ambulatory surgery center (ASC) where same-day discharge is inherently required. AIM To evaluate the impact of an opioid-sparing protocol (OSP) on patients undergoing spine surgery at an ASC. METHODS A retrospective study of 290 patients undergoing 1-2 level surgeries from 2022-2024 was performed. All procedures were performed by one fellowship trained orthopedic-spine surgeon in a hospital-affiliated ASC. Procedures included anterior cervical discectomy/fusion, lumbar laminectomy/discectomy and posterior lumbar fusion. Patients were classified based on whether they were managed postoperatively as usual care (UC) or using an OSP consisting of oral ketorolac, acetaminophen, ibuprofen, gabapentin, diazepam, and tramadol for breakthrough pain. Differences in patient demographics, comorbidities, surgical details, postoperative pain management, and outcomes between the UC (n = 208) and OSP (n = 82) groups were assessed using univariate statistics. RESULTS There were no significant differences in patient demographics, comorbidities, number of operative levels, or rates of anterior cervical discectomy/fusion and lumbar laminectomy/discectomy between groups. Patients in the OSP group had a shorter length of stay, were prescribed opioids less frequently in the recovery room, and were prescribed significantly fewer postoperative morphine-milligram-equivalents at discharge [30.0 (30.0-30.0) vs 140.0 (105.0-210.0); P < 0.001] compared to those in the UC group. There were no statistically significant differences in 30-day postoperative outcomes between groups. CONCLUSION The use of an opioid-sparing multimodal analgesia protocol for ambulatory spine surgery patients resulted in significant reductions in postoperative opioid consumption without compromising quality outcomes or increasing postoperative resource utilization. Evaluation of similar protocols is warranted to confirm these findings, which suggest opioid-sparing approaches to ambulatory spine surgery are both safe and effective.