Decreasing utilization of opioids and prescription nonopioids following lumbar discectomy

Lumbar discectomy may be considered for lumbar radicular symptoms. There have been recent pushes to reduce opioid use and promote multimodal pain management. This large administrative database study evaluated trends in pain management prescriptions following lumbar discectomy.

Lumbar discectomy patients were identified from the 2010-2021 PearlDiver M165Ortho database. Patients with prior history of substance abuse, neoplasm, or any concomitant anterior or posterior lumbar surgical intervention were excluded. Prescriptions of pain management drugs were evaluated in the 90-days following surgery and manually grouped as opioids and/or other categories of pain management drugs. Prescriptions and morphine milligram equivalents (MMEs) per 1,000 lumbar discectomy surgeries were determined and trended. Multivariable analysis was performed to determine clinical and nonclinical factors independently associated with opioid prescription use.

From a total of 93,252 lumbar discectomies meeting inclusion criteria, opioid prescriptions decreased from 531.7 per 1,000 lumbar discectomy surgeries in 2010 to 97.1 in 2021 (-81.7%). Prescriptions of other pain management drugs on aggregate decreased from 527.9 in 2010 to 174.9 in 2021 (-66.9%). The proportion of all analgesics prescribed postoperatively that were opioids decreased from 50.2% in 2010 to 35.7% in 2021. Among patients who received opioids in the 90-days postoperatively, MMEs prescribed per lumbar discectomy case decreased from 262.8 in 2010 to 24.6 in 2021 (-90.7%). Predictors of postoperative opioid prescriptions by multivariate analysis included clinical factors (younger age [OR 1.20 per decade decrease], male sex [OR 1.40], lower ECI [OR 1.16]) and the nonclinical factor of geographic variation (relative to South, Northeast OR 1.08, Midwest OR 1.09) (p<.05 for each).

Opioid prescriptions following lumbar discectomy have markedly decreased over the past decade. Notably, nonopioid prescriptions have also decreased, likely in favor of nonprescription multimodal pain management medications and strategies.