Opioid usage between unilateral biportal endoscopic, tubular, and open microdiscectomy
Nathan S Kim1, Brian T Bueno, Jay M Zaifman
1Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York.
Background:
Endoscopic spine surgery aims to reduce local tissue trauma and shorten recovery times, while maintaining the established benefits of open and tubular microdiscectomy. In the setting of the current opioid crisis, endoscopic spine surgery may minimize the need for short-term narcotic analgesics.
Purpose:
The aim of this study was to determine differences in opioid and nonopioid pain medication utilization after open, tubular, and unilateral biportal endoscopic (UBE) lumbar microdiscectomy.
Study Design:
This was a retrospective cohort study.
Methods:
Two hundred seventy patients (94 open, 56 tubular, and 120 UBE) were included in a retrospective cohort study. Postoperative pain medication prescription was recorded across the periods of discharge to 2 weeks, 2 to 6 weeks, 6 weeks to 3 months, and 3 to 6 months. Opioid prescription was converted to morphine milligram equivalents (MME). Chi-squared and Analysis of Variance statistical analyses, including Tukey post hoc testing, assessed differences between groups. Significance was set to P < .05.
Results:
Baseline demographics (age, sex, body mass index, American Society of Anesthesiologists grade) were similar across cohorts. Patients who underwent unilateral biportal endoscopic surgery required significantly less opioid medication early postoperatively (UBE: 150.7 ± 60.0 MME; open: 193.0 ± 85.9; tubular: 180.3 ± 83.0), although differences were not sustained beyond 2 weeks. Tukey post hoc testing demonstrated significantly lower opioid requirements in the UBE cohort than in open (-42.24 MME, P < .001) and tubular (-29.57 MME, P = .04) cohorts. Nonopioid analgesic requirements (muscle relaxants, NSAIDs, gabapentin, acetaminophen) were lower in the UBE group and persisted up to 3 months. Unilateral biportal endoscopic procedures had significantly longer operative times (UBE: 133.8 ± 39.1 minutes; open: 78.6 ± 32.8; tubular: 85.8 ± 25.9, P < .001). Hospital stay was significantly shorter for patients who underwent open surgery (open: 0.3 ± 0.2 days; UBE: 0.4 ± 0.5; tubular: 0.4 ± 0.6, P = .006). though clinically insignificant. Intraoperative and postoperative complications were otherwise comparable among groups.
Conclusion:
Unilateral biportal endoscopic microdiscectomy is associated with decreased requirement of opioid and nonopioid analgesics in the early postoperative period. Opioid requirements tend to converge across techniques after 2 weeks but overall remain low. Moreover, sustained reductions in nonopioid analgesic requirement beyond 2 weeks suggest improved long-term pain control compared with tubular and open microdiscectomy approaches.
Level Of Evidence:
Level 3.