Richard A. Berkman, M.D. performed 244 spine surgeries that were stratified into less invasive or more invasive procedures for analysis. The first cohort of 66 patients were given the option of receiving opioids as needed, but were not scheduled to receive opioids. The second cohort of 178 patients were only given opioids in extreme cases of ‘breakthrough pain.’” Pain was measured at discharge, and one week and one month after surgery.
There was no significant difference in pain scores between the first and second cohorts at any time point after surgery. The rate of opioid use after surgery was significantly associated with both preoperative opioid use (those not taking opioids before surgery were less likely to take them after surgery), and whether they were in the first or second cohorts (those in the first were significantly more likely to use opioids after surgery).
The invasiveness of the procedure was not significantly associated with opioid use after surgery. The study provides evidence that efforts to wean patients off of opioids before surgery, and to not voluntarily provide opioids can lead to lower rates of opioid use without increased levels of postoperative pain.
Another study in the issue, “How does preoperative opioid use impact postoperative health-related quality of life scores for patients undergoing lumbar microdiscectomy?” investigated preoperative opioid use and did not find a difference in outcomes after lumbar microdiscectomy whether the patient used opioids before surgery or not. This study, however, did not report post-operative opioid use rates.
Also published in the issue, the study titled “Are preoperative depression and anxiety associated with patient-reported outcomes, health care payments, and opioid use after anterior discectomy and fusion?” found that anxiety and depression are associated with many negative outcomes after anterior cervical discectomy and fusion (ACDF) procedures.
