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Post-operative Interventional Pain Procedures in the Elderly PopulationStewart G. Eidelson, M.D.
For many years, Dr. Eidelson has conducted research on treatment of spinal disorders. One of his particular research interests is in the treatment of the mature and/or elderly patient. This recent paper has been receiving wide readership in the spine community. We offer it for our visitors education.
DAVID EIDELSON, J.D., M.D.
STEWART EIDELSON, M.D.
VIVIENNE PAOLETTI, B.S.
Post-operative interventional pain procedures in the elderly population lowers the use of opioids and improves surgical outcomes following spinal fusion for degenerative spinal stenosis.
There is limited data showing the benefit of combining epidural nerve blocks during the first twelve months post-spinal surgery in reducing post-operative pain and improving surgical outcome. Elderly patients are well-known to have poor opioid tolerance due to their increased risk of cognitive impairment, urinary retention, respiratory depression, and gastrointestinal intolerance. The challenge for surgeons is how to limit the use of opioids during the postoperative period and still adequately control pain.
This pilot study aims to show that the use of epidural injections in the first 12 months post-spinal fusion can lessen the use of narcotics and improve surgical outcome including VAS and ODI scores.
METHODS: Between April 2014 and May 2016, 69 patients ages 65 to 88 underwent sequential spinal fusion for degenerative spinal stenosis with instability by one surgeon at the same institution. Data was collected by retrospective chart review and included VAS, ODI, narcotic usage, LOS, and blood loss over a 12 month time period. There were no opioId related complications. One wound infection and one pulmonary embolus was noted.
RESULTS: Average VAS scores decreased from 8.1 pre-surgery to 3.7 at 12 months. ODI improved from 39.9 to 21.18. Narcotic usage decreased from 67% to 6% at 12 months. Average blood loss was 321ml, LOS 2.5 days. 81% of patients had one or more comorbidities including cardiac, hypertension, diabetes, and obesity.
CONCLUSIONS : The lower usage of narcotics and improved surgical outcomes in the higher risk elderly population for lumbar spinal fusions suggests that surgeons should consider a combination of interventional pain procedures with standard postoperative care protocols.
Dr. Eidelson performs spine surgery at Leading Florida Hospitals.
Bethesda Hospital East
2815 S Seacrest Blvd
Boynton Beach, FL 33435
Boca Raton Regional Hospital
800 Meadows Rd
Boca Raton, FL 33486
Delray Medical Center
5352 Linton Blvd
Delray Beach, FL 33484