RECK effective opioid-sparing local anesthetic for patients undergoing posterior spinal fusion: study

Written by Dr Supreeth D R Published On 2025-08-12T20:30:24+05:30 | Updated On 12 Aug 2025 8:30 PM IST

RECK effective opioid-sparing local anesthetic for patients undergoing posterior spinal fusion: study

Ropivacaine-epinephrine-clonidine-ketorolac is an effective opioid-sparing local anesthetic for patients undergoing posterior spinal fusion: study

Ropivacaine-Epinephrine-Clonidine-Ketorolac (RECK) cocktail can improve pain control in patients undergoing lumbar decompression. Given the aging population, rising healthcare costs, the opioid epidemic, and associations of acute pain control with long-term opioid use, effective opioid-sparing analgesia following spinal fusion surgery may impart societal benefits.

Anthony V. Nguyen et al conducted a study to investigate whether RECK was an effective local anesthetic for patients undergoing posterior spinal fusion.

Primary outcomes were post operative pain levels as determined by Visual Analog Scale, in-hospital opioid consumption, length-of-stay<4days, and long-term opioid utilization at three months postoperatively. Secondary outcomes were rates of discharge to home, complication rates, readmissions within 90days.

The authors analyzed whether opioid exposure, patient-specific or surgery-specific factors, and administration of RECK (versus another local anesthetic) were associated with post operative pain levels, in hospital opioid consumption, length-of-stay, home discharge, long-term opioid utilization, complications, and readmissions within 90 days using multivariable regression.

KEY FINDINGS OF THE STUDY WERE:

• Of the162 patients meeting study criteria, 49(30.2%) received RECK.

• RECK was significantly associated with decreased pain levels at 2-,4-,6-, and 12-hours postoperatively (p≤.001−.01).

• RECK was associated with decreased total and daily inpatient opioid utilization (as measured by oral morphine equivalents) in multivariable linear regression (B=-159.6, 95% CI :-255.5−-63.6, p=.002andB=-27.9,95% CI :-48.9−-7.0, p=.01, respectively).

• Length-of stay duration of < 4days was associated with RECK administration (OR4.1,95%CI:1.4−13.2, p=.01) and was negatively associated with levels fused (OR0.4,95%CI:0.2−0.7, p=.005) and durotomy (OR0.02,95%CI:0.0009−0.1, p<.001).

• Prolonged post operative opioid utilization was associated with pre operative opioid prescription (OR3.6,95%CI:1.7−7.8,p=.001) and was negatively associated with RECK (OR0.4,95%CI:0.2−0.9,p=.04).

• RECK was not associated with readmissions, complications, or home discharge.

The authors concluded – ‘RECK administration during spinal fusion surgery was associated with decreased postoperative pain levels, inpatient opioid utilization, LOS, and chronic opioid use. It was not associated with increased complications or readmissions. Thus, RECK is a safe local anesthetic with opioid-sparing benefits for patients undergoing spinal fusion surgery and may reduce healthcare costs.’

MBBS, Dip. Ortho, DNB ortho, MNAMS

Dr Supreeth D R (MBBS, Dip. Ortho, DNB ortho, MNAMS) is a practicing orthopedician with interest in medical research and publishing articles. He completed MBBS from mysore medical college, dip ortho from Trivandrum medical college and sec. DNB from Manipal Hospital, Bengaluru. He has expirence of 7years in the field of orthopedics. He has presented scientific papers & posters in various state, national and international conferences. His interest in writing articles lead the way to join medical dialogues. He can be contacted at editorial@medicaldialogues.in.