Incidence and Risk Factors for Chronic Postoperative Opioid Use After Major Spine Surgery: A Cross-Sectional Study With Longitudinal Outcome

Dunn, Lauren K.; Yerra, Sandeep; Fang, Shenghao; Hanak, Mark F.; Leibowitz, Maren K.; Tsang, Siny; Durieux, Marcel E.; Nemergut, Edward C.; Naik, Bhiken I.

doi:10.1213/ane.0000000000003338

Cited by 113 publications

(98 citation statements)

References 37 publications

(48 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…More than 70% of patients presenting for major spinal surgery will already be taking opioids for pain relief. Preoperative opioid use combined with poorly controlled pain scores postoperatively have been identified as risk factors associated with opioid misuse during the postoperative period [ 23 ]. Given current public health concerns regarding addiction to prescription opioids administered postoperatively, particularly in the USA, there is a real need to focus our attention towards non-opioid based adjunctive analgesic strategies.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial

Finnerty

Buggy

2021

Trials

View full text Add to dashboard Cite

Background Spinal surgery can be associated with significant postoperative pain. Erector spinae plane (ESP) block is a new regional anaesthesia technique, which promises effective postoperative analgesia compared with systemically administered opioids, but has never been evaluated in terms of patient-centred outcomes such as quality of recovery and overall morbidity after major thoraco-lumbar spinal surgery. Methods We are conducting a prospective, randomised, double-blind trial in two hospitals in the Republic of Ireland. The sample size will be 50 patients (25 in the intervention group and 25 in the control group). Randomisation will be done using computer-generated concealed envelopes. Both patients and investigators collecting outcome data will be masked to group allocation. Participants will be male or female, aged 18 years and over, capable of providing informed consent and ASA grade I–IV. Patients scheduled to undergo posterior approach thoraco-lumbar decompression surgery involving 2 or more levels will be recruited to the study. Participants randomised to the intervention arm of the study will receive bilateral ultrasound-guided ESP block totalling 40 ml 0.25% levo-bupivcaine (20 ml each side), post induction of general anaesthesia and before surgical incision. The control group will not receive an ESP block. Both groups will receive the same standardised analgesic protocol both intra- and postoperatively. The primary outcome will be the quality of recovery at 24 h postoperatively as determined by the QoR-15 score. This score is determined by a questionnaire which measures patient responses to 15 subjective parameters, each response graded on a scale from 0 to 10. The maximum score achievable is 150 with a potential minimum score of 0. Higher scores indicate a higher quality of recovery experience. Secondary outcomes will include area under the curve (AUC) of VRS pain versus time at rest and on movement up to 24 h postoperatively, 24 h opioid consumption, time to first analgesia in recovery, length of stay (LOS), incidence and severity of postoperative complications as measured by the Comprehensive Complication Index (CCI) score. Discussion To the best of our knowledge, this will be the first randomised control trial to examine the efficacy and safety of the ESP block in terms of patient-centred outcomes in the setting of major spinal surgery. The QoR-15 is a validated means of assessing the quality of recovery after surgery and gives a more holistic assessment of the recovery experience from the patient’s point of view. Trial registration This trial is pre-registered on ClinicalTrials.gov reference number NCT04370951. Registered on 30 April 2020. All items from the World Health Organisation Trial Registration Data Set have been included.

show abstract

Section: Discussionmentioning

confidence: 99%

Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial

Finnerty

Buggy

2021

Trials

View full text Add to dashboard Cite

show abstract

“…Depression, the preoperative pain score, and chronic preoperative opioid use had been reported as important risk factors for postoperative pain and other complications [4,8,9]. However, the analysis of the patients’ psychological profiles or mental states was not routine at our institute.…”

Section: Discussionmentioning

confidence: 99%

“…This pain score may increase the incidence of delirium [6] and the duration of post-anesthesia care unit (PACU), thereby pushing up the cost of care [7]. Factors identified as possibly affecting the degree of postoperative pain were depression, preoperative pain score, and chronic preoperative opioid use [4,8,9].…”

Section: Introductionmentioning

confidence: 99%

Perioperative Factors Associated with Severe Pain in Post-Anesthesia Care Unit after Thoracolumbar Spine Surgery: A Retrospective Case-Control Study

et al. 2019

View full text Add to dashboard Cite

Study Design A retrospective case-control study. Purpose To evaluate the effect of nitrous oxide and anesthetic and operative factors associated with severe pain in the early postoperative period after thoracolumbar spine surgery. Overview of Literature Thoracolumbar spine surgery is the most common procedure in spine surgery, and up to 50% of the patients suffer from moderate to severe pain. Nitrous oxide has analgesic, anxiolytic, and anesthetic effects; nevertheless, its benefits for early postoperative pain control and opioid consumption remain to be established. Methods The medical records of eligible participants who underwent thoracolumbar spine surgery between July 2016 and February 2017 were reviewed. Enrolment was performed consecutively until reaching 90 patients for the case (severe pain) group (patients with a pain score of >7 out of 10 at least once during the post-anesthesia care unit [PACU] admission), and 90 patients for the control (mild-to-moderate pain) group (patients with a pain score of <7 in every PACU assessment). The data collected comprised patient factors, anesthetic factors, surgical factors, PACU pain score, and PACU pain management. Results A total of 197 patients underwent thoracolumbar spine surgery with an incidence of early postoperative severe pain of 53.3%. The case-control study revealed no differences in the factors related to pain intensity. A subgroup analysis was performed for failed back surgery syndrome (FBSS), spinal stenosis, and spondylolisthesis. After multivariate analyses, only the age group of 19–65 years and the baseline Oswestry Disability Index (ODI) were found to be significant risk factors for early postoperative severe pain in the PACU (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.32–6.25; OR, 1.03; 95% CI, 1.01–1.05, respectively). Conclusions Nitrous oxide, anesthetic agents, and surgical techniques did not affect the early postoperative pain severity. Age under 66 years and the baseline ODI were the significant risk factors for pain intensity during the early postoperative period of the FBSS, spinal stenosis, and spondylolisthesis subgroups.

show abstract

“…Risk factors include preoperative opioid use, preoperative pain, lower socioeconomic status, depression and antidepressant use, history of drug, alcohol or tobacco abuse and medical comorbidities [1,14]. Interestingly, PPSP has not been shown to be the primary determinant of persistent postoperative opioid use [15,16]. Given the harms demonstrated with long-term opioid use for chronic non-cancer pain, strategies for opioid cessation should be implemented concurrently with those that optimize postoperative pain.…”

Section: Acute Post Discharge Periodmentioning

confidence: 99%

Important considerations with respect to reducing the transition from acute to persistent postoperative pain

Kojic

Clarke

2021

Expert Opinion on Pharmacotherapy

View full text Add to dashboard Cite

Incidence and Risk Factors for Chronic Postoperative Opioid Use After Major Spine Surgery: A Cross-Sectional Study With Longitudinal Outcome

Cited by 113 publications

References 37 publications

Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial

Efficacy of the erector spinae plane (ESP) block for quality of recovery in posterior thoraco-lumbar spinal decompression surgery: study protocol for a randomised controlled trial

Perioperative Factors Associated with Severe Pain in Post-Anesthesia Care Unit after Thoracolumbar Spine Surgery: A Retrospective Case-Control Study

Important considerations with respect to reducing the transition from acute to persistent postoperative pain

Contact Info

Product

Resources

About