Enhanced Recovery Pathway Reduced Opioid Use and Pain Scores in Elective Spine Surgery

The purpose of this study was to determine if implementation of an enhanced recovery pathway (ERP) for elective spine surgery reduced opioid use and pain scores in elective spine surgery. A historical cohort study of 171 patients undergoing elective spine procedures between 2017 and 2021 was performed. The primary outcomes were opioid use and average daily pain scores. A group of 92 patients received the novel ERP (2019 – 2021) in comparison to a historical control group of 79 patients without the ERP (2017 – 2019). On postoperative days 1 to 3, the ERP group received 36% (p < 0.001), 36% (p < 0.001), and 37% (p = 0.005) less milligram morphine equivalents, respectively. On postoperative days 1 to 3, the ERP group pain scores were 1.5 (p < 0.001), 1.0 (p = 0.003), and 1.1 (p = 0.004) points lower, respectively. Length of stay was similar (4.3 vs. 4.5 days, p = 0.693). Adoption of this ERP protocol was associated with clinically significant reduced opioid consumption and pain scores in elective spine surgery. (Journ al of Surgical Orthopaedic Advances 33(3):162-167, 2024) Key words: enhanced recovery after surgery, ketamine, narcotics, opioids, pain management, perioperative care, spine