Abstract：
In response to the national opioid crisis, there have been increasing efforts to decrease opioid usage in favor of nonopioid alternatives. We compared post-discharge opioid and nonopioid pain medication prescriptions in lumbar microdiscectomy (MLD) patients before and after implementation of an opioid-sparing pathway for outpatient spine surgery. Patients were grouped into pre-implementation (pre) and post-implementation (post) cohorts based on date of surgery relative to pathway implementation on September 1, 2018. Primary outcomes were the average daily morphine milligram equivalent (MME) of opioids and percentages of nonopioids prescribed at 2-week, 6-week, and 3-month follow-up. Two hundred consecutive MLD patients (100 pre, 100 post) were evaluated. Pre-implementation, average daily MME significantly decreased from 19.59 at 2 weeks, to 1.73 at 6 weeks, to 0.11 at 3 months postoperatively (p < 0.001); post-implementation, average daily MME was 14.12, 1.31, and 0.27, respectively (p < 0.001). Average daily MME at 2-week follow-up decreased by 5.48 (p < 0.001) following implementation, while the rate of nonopioid prescriptions increased from 59% to 79% (p = 0.002) overall, specifically for acetaminophen (8% vs. 47%, p < 0.001) and nonsteroidal anti-inflammatory drugs (36% vs. 61%, p < 0.001). There were no significant differences at 6-week and 3-month follow-up. Opioid usage decreased while nonopioid pain medication usage increased from discharge to 2 weeks postoperatively. Beyond 2 weeks, opioid usage decreased significantly but were comparable between pre-implementation and post-implementation.
摘要：
为了应对国家阿片类药物危机，人们越来越努力减少阿片类药物的使用,转而使用非阿片类药物.我们比较了在门诊脊柱手术实施阿片类药物保留途径之前和之后，腰椎显微椎间盘切除术（MLD）患者的出院后阿片类药物和非阿片类药物止痛药处方。根据与2018年9月1日路径实施相关的手术日期，将患者分为实施前（前）和实施后（后）队列。主要结果是阿片类药物的平均每日吗啡毫克当量（MME）和2周时处方的非阿片类药物的百分比，6周,和3个月的随访。两百名连续MLD患者(100名患者，100个岗位)进行了评估。实施前,平均每日MME从2周时的19.59显着下降，到6周时的1.73，术后3个月降至0.11(p<0.001)；实施后，平均每日MME分别为14.12,1.31和0.27(p<0.001).实施后，2周随访时的平均每日MME减少了5.48（p<0.001），虽然非阿片类药物处方的比例从59%上升到79%(p=0.002)，特别是对乙酰氨基酚(8%vs.47%,p<0.001）和非甾体抗炎药（36%vs.61%,p<0.001)。在6周和3个月的随访中没有显着差异。从出院到术后2周，阿片类药物的使用减少，而非阿片类止痛药的使用增加。超过2周,阿片类药物的使用量显着下降，但在实施前和实施后具有可比性。
