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  • Complications Associated with the Over Use of Opioids for Pain Management in the Post-operative Period for Spine Patients: A Systemic Literature Review

    Final Number:
    1344

    Authors:
    Ramneek Dhillon; Luke Mugge; David Botschner; Brian Potocnik; Thomas Papadimos MD; Azedine Medhkour MD, FACS

    Study Design:
    Other

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: Because of the recent opioid crisis, much attention has been given to the management of pain and the quantity of medications used in healthcare. Within the context of neurosurgery, pain management for patients in the post-operative setting who have undergone cervical or lumbar spinal fusions is a major point of care. To date, no large scale, multi-center studies or meta-analysis have examined the consequences or complications associated with opioid use.

    Methods: A search of PubMed database was performed using the PRISMA guidelines for meta-analysis using the keywords: “opioid use in spinal fusions”, “cervical spinal fusion complications in opioid use”, “lumbar spinal fusion complications with opioid use”, “opioid use in postop complications”, and “spinal surgery post-op complications with opioid use.” Articles were first filtered for single center and multi-center studies. Articles included investigated the pre-, peri-, or post-operative use of opioids and assessed postsurgical complications.

    Results: The initial search identified 1478 articles. Thirteen articles met inclusion criteria and were assessed in full text with nine ultimately included. In spinal fusion surgeries, patients whose pain is managed with opioids have higher post-operative pain scores and worse quality of life compared to patients managed solely through non-medication regiments such as exercise. Both chronic and acute uses of opioids for pain management may be linked to post-operative complications following cervical and lumbar spinal fusion procedures. Opioid use prior to admission is associated with longer hospitalizations and a greater number of readmissions. The duration of opioid use in the year leading up to lumbar surgery or re-fusion surgery is associated with a longer duration of post-operative opioid use.

    Conclusions: This study suggests the presence of a correlation between opioid use and post-operative complications. Future studies are warranted to determine if opioid use in and of itself is responsible for more post-operative complications in spinal fusion patients.

    Patient Care: Opioids are over used in the post-operative period for the management of pain for spinal fusion patients and this could be directly associated with an increased number of post-operative complications.

    Learning Objectives: 1. Pain management is an essential component of clinical management of patients undergoing cervical or lumbar surgeries. 2. Use of opioids for the treatment of pain in the post-operative setting may not be effective for promoting successful and complication free outcomes. 3. Several studies indicate that there is an association between increased opioid use in the post-operative setting and the development of post-surgical complications. 2. Use of opioids for the treatment of pain in the post-operative setting may not be effective for promoting successful and complication free outcomes. 3. Several studies indicate that there is an association between increased opioid use in the post-operative setting and the development of post-surgical complications.

    References: 1. Connolly J 3rd, Javed Z, Raji MA, Chan W, Kuo YF, Baillargeon J. Predictors of Long-term Opioid Use Following Lumbar Fusion Surgery. Spine (Phila Pa 1976). 2017 Sep 15;42(18):1405-1411. doi: 10.1097/BRS.0000000000002133. 2. Jain N, Phillips FM, Weaver T, Khan SN. Pre-operative Chronic Opioid Therapy: A Risk Factor for Complications, Readmission, Continued Opioid Use and Increased Costs After One- and Two-Level Posterior Lumbar Fusion. Spine (Phila Pa 1976). 2018 Mar 20. doi: 10.1097/BRS.0000000000002609. 3. Layne EI, Roffey DM, Coyle MJ, Phan P, Kingwell SP, Wai EK. Activities performed and treatments conducted before consultation with a spine surgeon: are patients and clinicians following evidence-based clinical practice guidelines? Spine J. 2017 Sep 4. pii: S1529-9430(17)30976-2. doi: 10.1016/j.spinee.2017.08.259. 4. Villavicencio AT, Nelson EL, Kantha V, Burneikiene S. Prediction based on preoperative opioid use of clinical outcomes after transforaminal lumbar interbody fusions. J Neurosurg Spine. 2017 Feb;26(2):144-149. doi: 10.3171/2016.7.SPINE16284. 5. Wilson JL, Poulin PA, Sikorski R, Nathan HJ, Taljaard M, Smyth C. Opioid use among same-day surgery patients: Prevalence, management and outcomes. Pain Res Manag. 2015 Nov-Dec;20(6):300-4. doi:10.1155/2015/897491.

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