• Eli A Perez, Emanuel Ray, Colin J Gold, Brian J Park, Anthony Piscopo, Ryan M Carnahan, Matthew Banks, Robert D Sanders, Catherine R Olinger, Rashmi N Mueller, and Royce W Woodroffe.
• Department of Neurosurgery, University of Iowa Carver College of Medicine, Iowa City, IA.
• Spine. 2023 Dec 15; 48 (24): 173317401733-1740.

Study DesignRetrospective, single-center, cohort study.ObjectiveInvestigate whether the incidence of postoperative delirium in older adults undergoing spinal fusion surgery is associated with postoperative muscle relaxant administration.Summary Of Background DataBaclofen 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.MethodsPatients 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 one as part of a multimodal analgesia regimen. Doubly robust inverse probability weighting 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.ResultsThe incidence of delirium was 17.6% in the 250 patients who received postoperative muscle relaxants compared with 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 that patients who received muscle relaxants had a 2.00 (95% CI: 1.14-3.49) times higher risk of delirium compared with controls ( P=0.015 ).ConclusionPostoperative use of muscle relaxants as part of a multimodal 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.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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