Research Summary

RECK Cocktail Reduces Pain, Opioid Use, and Hospital Stay After Posterior Spinal Fusion

Kate Young

Key Highlights

  • Ropivacaine-epinephrine-clonidine-ketorolac (RECK) was associated with lower postoperative pain scores and reduced inpatient opioid use after posterior spinal fusion.
  • Patients receiving RECK had shorter hospital stays (< 4 days) compared with other local anesthetics.
  • RECK use was linked to decreased long-term opioid utilization at 3 months postoperatively.
  • No increase in complications, readmissions, or discharge outcomes was observed with RECK.

In a single-center retrospective cohort study, the use of a ropivacaine-epinephrine-clonidine-ketorolac (RECK)  cocktail demonstrated significant benefits for patients undergoing posterior spinal fusion. Compared with other local anesthetics, RECK was associated with improved early postoperative pain control, reduced opioid requirements, shorter hospital stays, and decreased long-term opioid use, without an increase in complications or readmissions.

Effective opioid-sparing analgesia is a critical need in the current clinical and societal landscape. With the aging population, rising healthcare costs, and the ongoing opioid epidemic, optimizing perioperative pain management strategies following spinal fusion surgery is particularly important. Acute pain control has been strongly linked to long-term opioid utilization, highlighting the relevance of investigating multimodal regimens such as RECK.

The investigators conducted a retrospective analysis of patients undergoing posterior spinal fusion between June 2019 and June 2021. The study compared outcomes among patients who received RECK versus another local anesthetic, using multivariable regression to assess associations with pain scores, opioid consumption, length of stay, discharge disposition, long-term opioid utilization, complications, and readmissions.

A total of 162 patients were included, of whom 49 (30.2%) received RECK. The study results showed that RECK use was significantly associated with lower pain scores at 2, 4, 6, and 12 hours postoperatively (P ≤ .001–.01). It was also associated with reduced inpatient opioid consumption, both total (unstandardized beta coefficient [B] = -159.6; 95% CI, -255.5 to -63.6; P = .002) and daily (B = -27.9; 95% CI, -48.9 to -7.0; P = .01). Patients receiving RECK were more likely to achieve a hospital stay of less than 4 days (OR, 4.1; 95% CI, 1.4–13.2; P = .01). Additionally, long-term opioid use was less likely among RECK recipients (OR, 0.4; 95% CI, 0.2–0.9; P = .04). RECK use did not correlate with differences in discharge to home, complication rates, or readmissions within 90 days.

As the authors concluded, “In patients undergoing posterior spinal fusion, RECK was superior to other local anesthetics as it improved pain control, decreased length-of-stay, and decreased opioid utilization. RECK was not associated with increased complications, readmissions, or rates of discharge to home.”

Reference:
Nguyen AV, Soto JM, Keith KA, Lyon KA, Rahm MD, Huang JH. Ropivacaine-epinephrine-clonidine-ketorolac is an effective opioid-sparing local anesthetic for patients undergoing posterior spinal fusion. Spine J. 2025;25(5):974-982. doi:10.1016/j.spinee.2024.11.021