Developing, Implementing, and Evaluating a Dexmedetomidine Infusion Protocol as an Opioid Sparing Technique in Spine Surgery

Background: Opioids have been the cornerstone treatment for surgical pain despite their negative side effects including the development of chronic postsurgical pain. Enhanced Recovery After Surgery helps to improve patient outcomes by using multimodal analgesics and limiting opioid administration. Dexmedetomidine is a sedative with notable opioid-sparing capabilities. Purpose: This quality improvement project aimed to develop and implement an evidence-based protocol that incorporated a dexmedetomidine infusion for patients undergoing spine surgery. Data was collected to analyze whether the results were consistent with the literature. Methods: Baseline data was collected prior to implementation of the protocol for 50 patients. An educational briefing regarding the protocol implementation was then completed for the anesthesia providers at Kalamazoo Anesthesiology to ensure familiarity with the protocol and benefits of dexmedetomidine as an analgesic. Post-implementation data was collected for all patients who received the full protocol correctly as well as any patients who received the correct dosage of dexmedetomidine. Results: Only 11 patients received the protocol in full while another 19 received at least the correct total dosage of dexmedetomidine. Out of all of the outcomes assessed, none reached statistical significance. However, time to rescue analgesic (p = .835) as well as PACU discharge time (p = .50) was shortest in the full protocol group. Interestingly, average opioid administration in each area was lowest among the partial protocol group. Conclusion: This quality improvement project’s results did not align with the current evidence likely in part due to lack of provider adherence. This project did however show a possibility of a decreased time to rescue analgesic and PACU discharge times which could be a reflection of a more balanced anesthetic when a dexmedetomidine infusion is utilized.