Opioid-free spine surgery: a prospective study of 244 consecutive cases by a single surgeon

There have been no reported efforts to eliminate opioid use for elective spine surgery, despite its well-known drawbacks. We sought to test the hypothesis that opioid-free elective spine surgery, including lumbar fusions, can be performed with satisfactory pain control. This study analyzes prospectively collected data from a single surgeon's patients who were enrolled into an institutional spine registry. We enrolled every consecutive surgical patient of author RAB between January 1, 2018 and July 13, 2019. The postsurgical opioid use, pain scores, emergency room visits, and readmissions were tracked. We developed a comprehensive program for opioid-free pain control after elective spine surgery. In the initial stage, opioids were given “PRN” only, while in the second stage, they were avoided altogether. Student's t tests were performed to compare pain scores, and regression analyses were performed to understand drivers of opioid use and pain. Two hundred forty-four patients were studied, a third of whom underwent lumbar fusions. In the initial stage, 47% of patients took no opioids from recovery room departure until 1-month follow-up. During the second stage, 88% of patients took no opioids during that period. Pain scores were satisfactory, and there was no association between postoperative opioid use and either procedural invasiveness or pain scores. However, preoperative opioid use was associated with a nearly fivefold increased risk of postoperative use. Ninety-three percent of lumbar fusion patients who were opioid-free before surgery did not take a single opioid in the postoperative period. Opioid-free elective spine surgery, including lumbar fusions, is feasible and effective. We suggest that opioid-free spine surgery be offered to patients who are opioid-naïve or who can be weaned off before the operation.