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

Abstract

Background: Persistent opioid use following surgery is common especially in patients with preoperative opioid use. This study aims to determine the long-term effect of an individualised opioid tapering plan versus standard of care in patients with a preoperative opioid use undergoing spine surgery at Aarhus University Hospital, Denmark. Methods: This is the 1-year follow-up of a prospective, single-centre, randomised trial of 110 patients who underwent elective spine surgery for degenerative disease. The intervention was an individualised tapering plan at discharge and telephone counselling 1 week after discharge, compared to standard of care. Postoperative outcomes after 1 year include opioid use, reasons for opioid use and pain intensity. Results: The overall response rate to the 1-year follow-up questionnaire was 94% (intervention group 52/55 patients and control group 51/55 patients). Forty-two patients (proportion = 0.81, 95% CI 0.67–0.89) in the intervention group compared to 31 (0.61, 95% CI 0.47–0.73; p =.026) patients in the control group succeeded in tapering to zero 1 year after discharge (p =.026). One patient (0.02, 95% CI 0.01–0.13) in the intervention group compared to seven patients (0.14, 95% CI 0.07–0.26) in the control group were unable to taper to their preoperative dose 1 year after discharge (p =.025). Back/neck and radicular pain intensity was similar between study groups. Conclusion: These results suggest that an individualised tapering plan at discharge combined with telephone counselling 1 week after discharge can reduce opioid use 1 year after spine surgery.