Choosing Wisely:

Don’t administer diazepam for muscle spasm following spine surgery in the elderly.

Rationale and Comments: Classic spine surgical treatment involves bilateral dissection of paraspinal muscles to expose the involved levels. Spasms of these muscles are common postoperatively. Treatment of these spasms should include both pharmacologic and non-pharmacologic interventions. Age-related changes in adults can affect both metabolism and drug elimination in the body, resulting in a prolonged half-life for medications. Among the benzodiazepines, diazepam is particularly problematic due to its long half-life and many active metabolites. Benzodiazepines can lead to over-sedation, potential for respiratory depression, increased risk of delirium, and extended in-hospital recovery time. Benzodiazepines have consistently been associated with falls in the aging population and should be avoided. Effective non-pharmacological interventions for use include heat, cold, repositioning, and massage.
Sponsoring Organizations:
  • American Academy of Nursing
  • Sources:
  • Expert consensus
  • Disciplines:
  • Orthopedic
  • Geriatric Medicine
  • References: • Brallier, J., Deiner, S. (2015) The elderly spine surgery patient: pre and intraoperative management of drug therapy. Drugs & Aging 32(8) 601-9
    • Choma, T., Rechtine, G., McGuire, R., Brodke, D. (2015) Treating the aging spine. Journal of American Academy of Orthopedic Surgeons. 23(12) 91-100.
    • Epstein, N.E. (2011) Spine surgery in geriatric patients: sometimes unnecessary, too much, or too little. Surgical Neurology International. 2, 188-194.
    • Garrido, M.M., Prigerson, H.G., Penrod, J.D., Jones, S.C., Boockvar, K.S. (2014). Benzodiazepine and sedative-hypnotic use among older seriously ill veterans: Choosing wisely? Clinical Therapeutics. 36(11) 1547-1554.
    • Huang, A.R., Mallet, L., Rochefort, C.M., Eguale, T., Buckeridge, D.L., Tamblyn, R. (2012) Medication related falls in the elderly: causative factors and preventive strategies. Drugs & Aging. 29950 359-376.
    • Neutel, C.I., Perry, S., Maxwell, C. (2002) Medication use and risk of falls. Pharmacoepidemiology Drug Safety. 11(2)97-104.

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