Postoperative Opioid Medication Consumption Following Single-Level Lumbar Microdiscectomy Before and After...

Area of Science:

• Pain Management
• Orthopedic Surgery
• Pharmacology

Background:

• The national opioid crisis necessitates reducing opioid dependence.
• Nonopioid alternatives are increasingly sought for pain management.
• Opioid-sparing pathways aim to decrease opioid use in surgical patients.

Purpose of the Study:

• To compare post-discharge opioid and nonopioid pain medication prescriptions.
• To evaluate the effectiveness of an opioid-sparing pathway for lumbar microdiscectomy (MLD) patients.
• To assess changes in pain management before and after pathway implementation.

Main Methods:

• A retrospective study comparing MLD patients before and after September 1, 2018.
• Two cohorts: pre-implementation (n=100) and post-implementation (n=100).
• Primary outcomes: average daily morphine milligram equivalent (MME) and nonopioid prescription rates at 2 weeks, 6 weeks, and 3 months.

Main Results:

• Average daily MME decreased significantly from 19.59 to 14.12 at 2 weeks post-implementation (p < 0.001).
• Nonopioid prescription rates increased from 59% to 79% overall at 2 weeks (p = 0.002).
• Significant increases observed in acetaminophen and NSAID use; no significant differences at 6 weeks or 3 months.

Conclusions:

• The opioid-sparing pathway effectively reduced opioid consumption and increased nonopioid use in the early postoperative period (2 weeks) for MLD patients.
• The pathway demonstrated a successful initial shift towards nonopioid pain management.
• Long-term differences in opioid usage were not significant beyond 2 weeks, suggesting sustained opioid reduction may require further interventions.