Opiate Consumption Following Lumbar Microdiscectomy

Introduction: Post-operative opiate prescribing has garnered appropriate attention in an effort to reduce risks associated with narcotic over-prescribing. This has been motivated not only by regulatory factors at a state-level, but in 2020 The Leapfrog Group developed a recommendation that post-operative prescribing conform to limits derived from expert consensus. Specific to Neurosurgery, the recommendation of Leapfrog was to limit post-operative prescriptions to twelve Oxycodone 5mg tablets.

Methods: For a 10-week period at a single Academic Medical Center all patients undergoing elective one-level lumbar microdiscectomy were surveyed to determine the number of tablets consumed, number of tablets remaining, and number of refills requested.

Results: We identified 50 patients undergoing a one-level microdiscectomy. Surgery was performed by 8 different surgeons. Two patients reported long-term pre-operative opiate use, and one reported opiate replacement therapy. The average consumption of all patients was 21.4 tablets (range 0-147 tablets). Forty-one patients received a prescription for thirty Oxycodone 5mg tablets, with two receiving tramadol, and seven receiving thirty Hydrocodone 5mg tablets. At one-month post-operatively, 27 (54%) consumed more than 12 tablets, thirty-seven patients (74%) required no refills, nine required one refill (18%), and four required more than one refill (8%). Of patients requesting no refills, they reported an average of 18 remaining tablets, with 12 consumed. Only one patient (2%) reported dissatisfaction with the medications that you were provided by our practice, while 49 (98%) were satisfied with the amount of medication provided.

Conclusion : While the number of tablets consumed following elective lumbar microdiscectomy averages less than the average number of pills dispensed, the range of tablets consumed demonstrates that only 46% of patients utilize less than 12 tablets. This implies that if the number of tablets were reduced to 12 it would likely increase the number of refill requests, which would increase the administrative burden and potentially patient costs.