Moon Andrew S, LeRoy Taryn E, Yacoubian Vahe, Gedman Marissa, Aidlen Jessica P, Rogerson Ashley
Department of Orthopaedic Surgery, Tufts Medical Center, Boston, MA, USA.
Tufts University School of Medicine, Boston, MA, USA.
Global Spine J. 2024 Jan;14(1):204-210. doi: 10.1177/21925682221099857. Epub 2022 May 10.
Retrospective review.
Cannabis is an antinociceptive which has been evaluated as a possible adjunct or substitute for opioid use in the treatment of acute pain. The aim of this study was to evaluate the association between preoperative cannabis usage and consumption of opioids for postoperative analgesia.
Patients who underwent one- or two-level posterior lumbar fusion surgery were categorized as cannabis users or non-cannabis users based on preoperative diagnoses of cannabis use. Total morphine equivalent dose was calculated for both in-house opioid consumption and postoperative prescription opioid usage. Age, ASA, BMI, depression, tobacco use, estimated blood loss, OR time, LOS, disposition to rehab, 30-day readmission, in-house opioid consumption and postoperative prescription opioid usage were compared between groups using t-tests.
Of the 220 opioid naïve patients, 29 (13%) patients were identified as cannabis users while 191 (87%) were non-cannabis users. There were no significant associations between opioid naïve cannabis usage and ASA, BMI, tobacco use, EBL, OR time, LOS, disposition to rehab, or readmission. Opioid naïve cannabis users had greater association with depression (31.3% vs 13.7%, P=.017) and younger age (56.37 years vs 65.37 years, P<.001). Interestingly, cannabis use was associated with a lower Charlson Comorbidity Index (CCI), with 1.38 vs 2.49 (P=.002). Cannabis users were found to have increased postoperative prescription opioid usage (2545.41 POST-MED vs 1379.72 POST-MED, P=.019).
Cannabis usage is associated with increased usage of opioids postoperatively, both while in-patient and post-discharge, after posterior lumbar spinal fusion surgery.
回顾性研究。
大麻是一种具有镇痛作用的物质，已被评估为在急性疼痛治疗中可能作为阿片类药物使用的辅助药物或替代品。本研究的目的是评估术前大麻使用与术后镇痛阿片类药物消耗之间的关联。
接受单节段或双节段后路腰椎融合手术的患者根据术前大麻使用诊断分为大麻使用者或非大麻使用者。计算住院期间阿片类药物消耗和术后处方阿片类药物使用的总吗啡当量剂量。使用t检验比较两组之间的年龄、美国麻醉医师协会（ASA）分级、体重指数（BMI）、抑郁、吸烟情况、估计失血量、手术时间、住院时间、康复倾向、30天再入院率、住院期间阿片类药物消耗和术后处方阿片类药物使用情况。
在220例未使用过阿片类药物的患者中，29例（13%）被确定为大麻使用者，191例（87%）为非大麻使用者。未使用过阿片类药物的大麻使用与ASA分级、BMI、吸烟情况、估计失血量、手术时间、住院时间、康复倾向或再入院率之间无显著关联。未使用过阿片类药物的大麻使用者与抑郁的关联更大（31.3%对13.7%，P = 0.017）且年龄更小（56.37岁对65.37岁，P < 0.001）。有趣的是，大麻使用与较低的查尔森合并症指数（CCI）相关，分别为1.38对2.49（P = 0.002）。发现大麻使用者术后处方阿片类药物使用增加（术后用药量2545.41对1379.72，P = 0.019）。
后路腰椎脊柱融合手术后，大麻使用与住院期间和出院后术后阿片类药物使用增加有关。
