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Background: Exposure to opioids, preoperatively or during surgery, is a significant risk factor for developing opioid addiction and may increase the risk of acute tolerance and chronic use. More specifically, spinal lumbar surgery is associated with increased opioid requirements to counter associated pain secondary to lumbar manipulation. Currently, there is a lack of studies that exemplify the anesthetist’s role in minimizing narcotic use while effectively managing pain for this patient-specific population. Dexmedetomidine, an alpha-2 agonist, administered as a continuous infusion, has been shown to reduce opioid consumption in spinal lumbar surgery patients.
Context: The implementation phase of this quality improvement project was completed through the voluntary participation of Miami Beach Anesthesiology Associates (MBAA) at Mount Sinai Medical Center. MBAA provides all anesthesia services for Mount Sinai Medical Center, a not for-profit, private teaching hospital located in Miami Beach, Florida.
Objectives: The purpose of this study is to improve anesthesia provider knowledge on the role of continuous dexmedetomidine infusion to reduce opioid consumption in patients undergoing spinal lumbar surgery. A literature review including seven research studies addresses the PICO question “In adult patients undergoing lumbar spine surgery does the administration of continuous intravenous dexmedetomidine perioperatively compared to pain management with a traditional opioid approach lead to decreased perioperative opioid administration without an increase in reported pain postoperatively?” The literature review was used as the basis for this study and served as the educational framework to increase anesthesia provider knowledge.
Methodology: The primary methodology used for the proposed project was administered through an online educational module. A pre-implementation survey assessed anesthesia provider knowledge of the current opioid crisis in the United States, dexmedetomidine’s role in reducing opioid requirements, and factors that have prevented the use of dexmedetomidine.
Results: There was an overall improvement in anesthesia provider knowledge between pre-test and post-test survey responses following the online educational module. It can be assumed that most providers feel more inclined to use dexmedetomidine for this type of surgery.
Conclusions: Currently, continuous dexmedetomidine infusion is not used as an adjuvant with opioids for spinal lumbar surgery patients. Fentanyl is the intraoperative opioid most utilized to control pain combined with other opioid and non-opioid drugs determined by individual providers. The educational intervention effectively improved provider awareness regarding opioid misuse risk factors, dexmedetomidine’s clinical uses, and favoring dexmedetomidine to reduce opioid consumption for this type of surgery. There are still factors that prevent the use of dexmedetomidine that may stem from the medical direction of other anesthesia providers that did not partake in this study.
Otte, Michael; Alfonso, Fernando; and Mato, Jampierre, "The Use of Continuous Perioperative Dexmedetomidine Infusion to Reduce Opioid Consumption in Adult Patients Undergoing Spinal Lumbar Surgery: A Quality Improvement Project" (2021). Nicole Wertheim College of Nursing Student Projects. 90.
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