• Lokeshwar S Bhenderu, Kristopher A Lyon, Jose M Soto, William Richardson, Ronak Desai, Mark Rahm, and Jason H Huang.
• Department of Neurosurgery, Baylor Scott & White Medical Center, Temple, Texas, USA. Electronic address: Lbhenderu@tamu.edu.
• World Neurosurg. 2023 Aug 1; 176: e515e520e515-e520.

ObjectiveThe goal of this study is to discuss our initial experience with a multimodal opioid-sparing cocktail containing ropivacaine, epinephrine, clonidine, and ketorolac (RECK) in the postoperative management of lumbar decompression surgeries.MethodsPatients were either administered no local anesthetic at the incision site or were administered a weight-based amount of RECK into the paraspinal musculature and subdermal space surrounding the operative site once the fascia was closed. We performed a retrospective chart review of all patients 18 years of age or older undergoing lumbar laminectomy and lumbar diskectomy surgeries between December 2019 and April 2021. Outcomes including total opioid use, measured as morphine milligram equivalent, length of stay, and postoperative visual analog scores for pain, were collected. Relationships between variables were analyzed with Student's t-test, chi-square tests, and Fisher exact tests.ResultsA total of 121 patients undergoing 52 lumbar laminectomy and 69 lumbar diskectomy surgeries were identified. For lumbar laminectomy, patients who were administered RECK had decreased opioid use in the postoperative period (11.47 ± 12.32 vs. 78.51 ± 106.10 morphine milligram equivalents, P = 0.019). For patients undergoing lumbar diskectomies, RECK administration led to a shorter length of stay (0.17 ± 0.51 vs. 0.79 ± 1.45 days, P = 0.019) and a lower 2-hour postoperative pain score (3.69 ± 2.56 vs. 5.41 ± 2.28, P = 0.006).ConclusionsThe RECK cocktail has potential to be an effective therapeutic option for the postoperative management of lumbar decompression surgeries.Copyright © 2023 Elsevier Inc. All rights reserved.

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