Introduction: Opioid prescription has received a great deal of scrutiny in recent media and scientific literature, with post-operative opioid use being no exception. Recent clinical practice guidelines from the Department of Veterans Affairs and Department of Defense strongly recommend against the combination of benzodiazepines and opioids as well as the initiation of long-acting opioids (LAO) for acute pain. The present study evaluated the impact of removing benzodiazepines and LAOs from post-operative prescribing patterns on patients’ pain control.

Methods: A retrospective review of patients undergoing a single-level transforaminal lumbar interbody fusion (TLIF) was performed at our institution before and after removing benzodiazepines and LAOs from our order sets. The remaining regimen of acetaminophen, muscle relaxants (methocarbamol and cyclobenzaprine), oxycodone immediate release, and a hydromorphone PCA did not change. Patient-reported pain scores on the visual analog scale, morphine equivalent usage, and length of hospitalization data were obtained from the medical record and subsequently analyzed with two-tailed, independent group t-tests.

Results: 63 patients (42 patients treated with sustained release oxycodone and diazepam [Group1] and 21 not [Group2]) were included in the present study. The majority of patients in both groups were male (Group1 =64.29%; Group2 =76.19%) with no difference in age (Group1 =48.09 years, Group2 =50.95 years, p=0.46) or pre-operative opioid use (Group1 =42.85%, Group2 =47.61%, p=0.73). Post-operatively, there was no change in mean pain scores (Group1 =4.36, Group2 =4.99, p=0.14), average daily morphine equivalents (Group1 =42.51, Group2 =49.84, p=0.30), or length of hospitalization (Group1 =4.48, Group2 =4.10, p=0.28).

Conclusions: Post-operative pain control after single level TLIFs does not differ with the removal of benzodiazepines and LAOs. The removal of these agents therefore, decreases the risk of adverse outcomes that patients are subjected to, without a negative outcome to the patient.

Patient Care: This research demonstrates that equivalent pain control for patients undergoing spine surgery can be obtained in the immediate post-operative period without the use of benzodiazepines or long-acting opioids, both of which have been tied to increased risk of adverse outcomes including death in multiple recent publications.

Learning Objectives: By the conclusion of this session, participants should be able to: 1)Describe the risks associated with the use of benzodiazepines and opioids concurrently and the risks of long-acting opioid initiation; 2)Recognize the ability to have equivalent outcomes in post-operative patients without the use of these agents.

References: Jack M. Rosenberg, Brandon M. Bilka, Sara M. Wilson, Christopher Spevak; Opioid Therapy for Chronic Pain: Overview of the 2017?US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline, Pain Medicine, pnx203, https://doi.org/10.1093/pm/pnx203.