Patterns of Outpatient Multimodal Analgesic Use Among Postoperative Marijuana Users Undergoing ACDF and Lumbar Fusion.

Abstract

Study design: Retrospective cohort study.

Objectives: To describe patterns of postoperative analgesia use (opioids, antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines) among postoperative marijuana users after anterior cervical discectomy and fusion (ACDF) and lumbar fusion.

Summary of background data: The use of marijuana for pain management is a controversial topic that lacks extensive research. As social and legal acceptance of marijuana increases, questions have arisen about its therapeutic potential alongside prescription analgesic pharmaceutical agents, necessitating further studies on this topic.

Methods: Adult patients who underwent either ACDF or lumbar fusion surgery and used marijuana postoperatively were identified. A 1:1 propensity match incorporating patient demographics and levels fused was conducted to compare postoperative marijuana users to nonmarijuana users. One year preoperative and 1 year postoperative opioid use was obtained from the Pennsylvania Prescription Drug Monitoring Program (PDMP). Preoperative and postoperative utilization of antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines was obtained from patient chart review and PDMP.

Results: Of the 126 included patients, 63 (50%) used marijuana postoperatively. A greater proportion of marijuana users undergoing lumbar fusion used opioids preoperatively compared with nonmarijuana users (P=0.048). No significant differences in preoperative opioid use were demonstrated among ACDF patients. In both ACDF and lumbar fusion cohorts, no differences in postoperative opioid consumption were observed between marijuana and nonmarijuana users. Marijuana usage was associated with higher utilization of serotonin-norepinephrine reuptake inhibitors (SNRIs), specifically duloxetine, in the ACDF cohort (P=0.024). No significant differences in rates of utilization of tricyclic antidepressants, gabapentinoids, muscle relaxants, and benzodiazepines were observed in patients who consumed marijuana compared with nonmarijuana users.

Conclusions: Postoperative marijuana use was significantly associated with preoperative opioid use in lumbar fusion patients and duloxetine use in ACDF patients. Postoperative marijuana use was not significantly associated with gabapentinoid, muscle relaxant, or benzodiazepine use.