Journal article
Postoperative Use of the Muscle Relaxants Baclofen and/or Cyclobenzaprine Associated with an Increased Risk of Delirium Following Lumbar Fusion
Spine (Philadelphia, Pa. 1976), Vol.48(24), pp.1733-1740
12/13/2023
DOI: 10.1097/BRS.0000000000004606
PMID: 36799727
Abstract
Retrospective, single-center, cohort study.
Investigate whether the incidence of postoperative delirium in older adults undergoing spinal fusion surgery is associated with postoperative muscle relaxant administration.
Baclofen and cyclobenzaprine are muscle relaxants frequently used for pain management following spine surgery. Muscle relaxants are known to cause central nervous system side effects in the outpatient setting and are relatively contraindicated in individuals at high-risk for delirium. However, there are no known studies investigating their side effects in the postoperative setting.
Patients over 65 years of age who underwent elective posterior lumbar fusion for degenerative spine disease were stratified into two treatment groups based on whether postoperative muscle relaxants were administered on postoperative day 1 as part of a multimodal analgesia regimen. Doubly robust inverse probability weighting (IPW) with cox-regression for time-dependent covariates was used to examine the association between postoperative muscle relaxant use and the risk of delirium while controlling for variation in baseline characteristics.
The incidence of delirium was 17.6% in the 250 patients who received postoperative muscle relaxants compared to 7.9% in the 280 patients who did not receive muscle relaxants (P=0.001). Multivariate analysis to control for variation in baseline characteristics between treatment groups found patients who received muscle relaxants had a 2.00 (95% CI: 1.14-3.49) times higher risk of delirium compared to controls (P=0.015).
Postoperative use of muscle relaxants as part of a multi-modal analgesia regimen was associated with an increased risk of delirium in older adults after lumber fusion surgery. Although muscle relaxants may be beneficial in select patients, they should be used with caution in individuals at high risk for postoperative delirium. Additional work is needed to further examine the risks and benefits of postoperative muscle relaxant administration.
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Details
- Title: Subtitle
- Postoperative Use of the Muscle Relaxants Baclofen and/or Cyclobenzaprine Associated with an Increased Risk of Delirium Following Lumbar Fusion
- Creators
- Eli A Perez - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USAEmanuel Ray - University of IowaColin J Gold - Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA, USABrian J Park - University of IowaAnthony Piscopo - University of IowaRyan M Carnahan - University of IowaMatthew Banks - University of Wisconsin–MadisonRobert D Sanders - Royal Prince Alfred HospitalCatherine R Olinger - University of IowaRashmi N Mueller - Department of Anesthesia, University of Iowa Carver College of Medicine, Iowa City, IA, USARoyce W Woodroffe - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Spine (Philadelphia, Pa. 1976), Vol.48(24), pp.1733-1740
- DOI
- 10.1097/BRS.0000000000004606
- PMID
- 36799727
- NLM abbreviation
- Spine (Phila Pa 1976)
- eISSN
- 1528-1159
- Language
- English
- Electronic publication date
- 02/15/2023
- Date published
- 12/13/2023
- Academic Unit
- Epidemiology; Orthopedics and Rehabilitation; Nursing; Anesthesia; Injury Prevention Research Center; Neurosurgery
- Record Identifier
- 9984366381302771
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