American Society for Peripheral Nerve

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Patterns of Opioid Use Among Peripheral Nerve Surgery Patients
Katherine Bernadette Santosa, MD, MS1; Jodi B Lapidus, MPHS1; Ellen Larson, BS2; Linh Vuong, BA3; Amy M Moore, MD4; Alison K. Snyder-Warwick, MD1; Jennifer F. Waljee, MD, MPH, MS5; Susan E. Mackinnon, MD4
1Washington University School of Medicine, St. Louis, MO, 2Washington University in St. Louis, St Louis, MO, 3Washington University, Saint Louis, MO, 4Department of Surgery, Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, Saint Louis, MO, 5Section of Plastic Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI

Introduction: Managing patients' pain in the setting of nerve pathology is challenging for providers, particularly in the perioperative arena. An important yet understudied component of pain management in this population is opioid utilization. Therefore, the goal of this study was to evaluate the patterns of opioid use among patients undergoing peripheral nerve surgery pre- and post-operatively.

Materials and Methods: We performed a retrospective cohort study of adult patients treated at an upper extremity/peripheral nerve surgery clinic between June 2016 and October 2017. Patients underwent carpal tunnel release, cubital tunnel release, Guyon's canal release, peroneal nerve release, or brachial plexus reconstruction. We evaluated the electronic medical records of patients to evaluate patient demographics, treatment characteristics, and pre- and post-operative opioid use. Additionally, we utilized a pain evaluation questionnaire designed by the senior author to examine the level and quality of pain in the perioperative period. Patients were assigned to two groups based on their pre-operative opioid use: (1) na´ve (i.e. no opioid use before surgery); (2) chronic (i.e. opioid use before surgery). Comparisons between the groups were done via Fisher's exact tests.

Results: Overall, we comprehensively analyzed data from 136 patients. Of these, 72.8% (n=99) of patients were opioid na´ve while 27.2% (n=37) had used opioids pre-operatively. Chronic opioid users had higher numbers of prior surgeries and were more likely to have histories of major accidents or illicit drug use compared to opioid na´ve patients. On pre-operative pain questionnaires, distribution of patient-reported depression, frustration, anger, and pain were significantly different between the two cohorts with a higher distribution of chronic opioid users reporting levels in the highest quintile in all domains. Additionally, 3 months after peripheral nerve surgery, 57% of chronic opioid users were not using any type of opioid medication.

Conclusions: More than one-quarter of patients presenting for peripheral nerve surgery reported pre-existing use of opioid medications. Additionally, opioid na´ve and opioid chronic patients presenting for peripheral nerve surgery are significantly different in their reported levels of depression, frustration, anger and pain at baseline. Fortunately, a majority of patients undergoing peripheral nerve surgery who previously were using opioid pre-operatively did not use opioids 3 months after surgery, suggesting an important role of peripheral nerve surgery on the treatment of chronic pain conditions.

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