A promising pain management treatment plan used for spine surgery lessened patients’ pain and reduced opioid use by 35 percent, according to a study by Corewell Health East, the new name for Beaumont Health, and has led to a statewide recommendation to establish the same treatment plan for all spine surgery patients.
Administering an intravenous (IV) dose of long-acting methadone, an old drug with a new twist, in the operating room provided better long-term pain relief when compared to a patient intermittently pushing a button to administer their own doses of short-acting opioid medication after their procedure, according to a retrospective study that looked at both approaches led by Dr. Richard Easton, chief of Orthopedic Surgery at Corewell Health Beaumont Troy Hospital.
The use of long-acting IV methadone in this way, the basis for an enhanced recovery after surgery (ERAS) treatment plan, originated in cardio-thoracic surgery. Easton and Dr. Daniel Silvasi, surgical director of clinical operations and medical director of operating rooms at Corewell Health Beaumont Troy Hospital, and their team were the first in Michigan to apply this particular ERAS approach to lumbar fusion, or spine surgery.
The study’s results were first published in The Spine Journal, a publication of the National Association of Spine Specialists, and presented at the 2022 Annual Congress of Enhanced Recovery and Perioperative Medicine in Baltimore by Corewell Health anesthesiologist Dr. Greg Smith, the study’s co-investigator. In October, Easton shared the work at the North American Spine Society’s 37th Annual Meeting in Chicago.
“We have found some success in pain management and patient outcomes applying the ERAS pain management principles to spine surgery at Beaumont Health, now Corewell Health East,” Easton says. “We have included standard practices used since ERAS’ inception in the 1990s, including educating patients before their procedure, standardizing treatment for pain relief, helping patients become mobile as early as possible and advising on helpful nutrition during recovery. All of this helps patients take an active role in their care.”
The study also found this approach shortened patients’ length of stay in the hospital, lowered the overall hospital costs, and lessened some common post-operative events like hypotension and urinary retention.
Positive results of implementing the ERAS treatment led the Michigan Spine Surgery Improvement Collaborative (MSSIC), a statewide quality improvement collaborative dedicated to improving care during spine surgery, to recommend hospitals establish the ERAS treatment as a standard practice to be compared and evaluated at different hospitals. Spine surgeons and representatives from other Michigan health systems visited Corewell Health Beaumont Troy Hospital this summer to learn more about Corewell Health East’s ERAS protocol.
“This new approach has had some success, and is key to team support from doctors, anesthesiology, nursing and allied services,” Silvasi says. “We’re changing the way things are done. We’re changing how staff is caring for patients, and how patients are caring for themselves.”
To evaluate the impact of the pain management approach, the study compared outcomes before and after patients followed the ERAS treatment. The study looked at a total of 338 patients who underwent lumbar fusion surgery in 2018 and 2019. More than 190 (192) patients followed traditional pain management, and 146 were treated under the new ERAS pain management plan.
To help establish the practice, the team produced educational materials in the form of videos, posters ,and brochures to re-train staff and educate patients.
“We’re changing a culture to successfully implement a new treatment plan to assist patients,” Easton says. “Staff and patient engagement are critical to our ERAS journey success.”
The ERAS treatment plan also has been adopted at Corewell Health Beaumont Troy Hospital for patients undergoing laminectomy — decompression of a spinal area that had been causing pain — as well as cervical (neck) fusion and lumbar (low back) revision procedures.
