American Academy of Nursing

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March 21, 2017

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

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.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a workgroup of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The workgroup collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy workgroup fellows narrow the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

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.