Nancy A. Melville – May 10, 2017
LOS ANGELES — The preoperative use of opioid analgesics is associated with worse clinical postoperative outcomes at 12-month follow-up of lumbar fusion surgery for degenerative lumbar conditions, new research shows.
“The results suggest the use of opioid medication is a potentially modifiable factor that could be controlled to maximize clinical outcomes,” said first author, Alan T. Villavicencio, MD, from Boulder Neurosurgical Associates, Colorado.
He presented the findings here at the American Association of Neurological Surgeons (AANS) 2017 Annual Meeting.
While a high number of patients with low back pain can be expected to have been prescribed opioid medications for pain, research on the relationship between use of the medications before surgery and lumbar fusion surgery outcomes is lacking.
For the prospective study, Dr Villavicencio and colleagues enrolled 93 patients receiving one- to two-level transforaminal lumbar interbody fusion surgeries for degenerative low back conditions.
Of the patients, who had an average age of 59 years, 60 (64.5%) had preoperatively used prescribed opioids, with an average preoperative dose of 64.4 mg (range, 10 to 270 mg).
Demographic and surgical characteristics did not significantly differ between patients who did and didn’t have preoperative opioid use, with the exception of average symptom duration, which was longer in nonusers (113 months vs 56 months; P = .008).
In the opioid use group, preoperative disability was higher than in nonusers (average Oswestry Disability Index, 40.3 vs 33.7; P = .04) and measures of mental health were lower (Short Form-36 [SF-36] Mental Component Summary [MCS], 42.7 vs 49.2; P = .01).
However, other clinical scores of back and leg pain visual analogue scale and SF-36 Physical Component Summary (PCS) were not statistically different.