Shared decision-making approach to taper postoperative opioids in spine surgery patients with preoperative opioid use: a randomized controlled trial

Abstract

Supplemental Digital Content is Available in the Text.In surgical patients with preoperative opioid use, a personalized tapering plan and follow-up counselling may be effective in reducing opioid consumption after surgery.

An individualised tapering protocol reduces opioid use 1 year after spine surgery: A randomised controlled trial of patients with preoperative opioid use

“…A sample size calculation is outlined previously. 16 Continuous data were tested for normal distribution using QQ-plots and the Student's t test and Mann-Whitney U test were applied as appropriate. Ordinal variables were treated as nonnormally distributed continuous data and reported as medians with interquartile ranges (IQRs).…”

“…The tapering protocol is described in more detail elsewhere and an example of an opioid tapering plan and telephone counselling is also presented. 16 In summary, the opioid tapering plan was made as a shared decision-making process between the primary investigator and the patient on the day of discharge. The setting was a single patient room with only the investigator, the patient, and in some cases a relative, present.…”

“…14,15 In fact, we have recently shown in a randomised controlled trial (RCT) of 110 patients with preoperative opioid use who underwent spine surgery that an individualised tapering plan at discharge and telephone follow-up 1 week after discharge was effective in reducing opioid consumption 2 weeks, 1 and 3 months after discharge. 16 Therefore, we decided to carry out this 1-year follow-up study with the aim to investigate whether these promising results would also apply after 1 year. We hypothesised that the shared decision-making approach would reduce persistent postoperative opioid use 1 year after discharge from surgery, compared to standard of care.…”

“…ing the initial study was released in 2020 and the results from the up to 3-month follow up of the trial were published in 2022. 16,17 The initial trial protocol will now be described briefly. To be included in the trial, patients were required to have daily opioid consumption at least 14 days leading up to surgery.…”

How to close the gaps between evidence and practice for perioperative opioids

“…Any decrease in opioid dose must be well supported by the patient's primary care providers. 13 Patients and clinicians should be encouraged and reassured that substantial evidence demonstrates that voluntary weaning does not worsen, and may improve, pain scores and may significantly improve the effectiveness of postoperative analgesia. 14,15 Modifiable psychosocial risk factors that are more common in those patients taking opioid and sedative drug combinations may be addressed through services such as psychology or multidisciplinary pain services.…”