American Association of Neuroscience Nurses, Society of Pediatric Nurses & American Pediatric Surgical Nurses Association, Inc.

View all recommendations from this society

December 1, 2022

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

(1–5 & 8) Members of the American Association of Neuroscience Nurses formed a task force to review evidence and make a recommendation of 5–10 things nurses should tell neuroscience patients to consider. AANN’s Special Focus Groups, which are composed of subject matter experts in various subspecialties of neuroscience, were consulted to help identify topics and provide supporting evidence. The task force reviewed the items for possible inclusion to determine the top recommendations. The top recommendations were presented to the AANN Board for review and approval.

(6) SPN initially reached out to several subject matter experts to learn about topic areas where they were aware of both evidence of overuse of health care resources and evidence-based resources to support addressing that overuse. SPN then chose two experts with research experience within the topic area we identified. One served as the main author while the other served as the reviewer. After the initial review was completed, we shared the content with the SPN Board of Directors for further input. Finally, colleagues at the American Academy of Nursing provided a final review.

(7) Once the American Pediatric Surgical Nurses Association, Inc. (APSNA) received an invitation from the Institute of Pediatric Nursing (IPN) to participate in the initiative, the APSNA Board was queried to identify pediatric nursing practices that should be modified based on evidence. The identified practice was presented to experts from APSNA’s Board of Directors, General Membership and Trauma Special Interest Group (SIG). The preliminary statement was reviewed and revised by content experts from both within and outside of the organization. Subsequently, the statement was submitted to the APSNA Board for final discussion and review. The final statement was reviewed and approved by the American Academy of Nursing.


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.