Patterns of Opioid Use Following Operative Treatment of Distal Radius Fractures: Comparison and Predictive Factors for Diminished Need in Cannabis Users
Nayun Lee, BS1, Elliot L.H. Le, MD, MBA2 and Matthew L. Iorio, MD1, (1)University of Colorado School of Medicine, Aurora, CO, (2)University of Colorado School of Medicine, Aurora, NC
Background: The prevalence of patients reporting cannabis use has increased in recent years with the legalization of cannabis in several states in the United States. However, there is a lack of research investigating sustained cannabis use prior to surgery and its effect on acute pain management, especially in post-traumatic hand surgery. The purpose of this study is to compare opioid consumption between cannabis users and non-cannabis users following open reduction and internal fixation (ORIF) of distal radius fractures.
Methods: The commercially available patient database PearlDiver was queried for patients undergoing ORIF of DRF between 2010 and 2020. The study population was categorized into two groups based on ICD-10 diagnosis: those with a history of cannabis use disorder (case) and those without (control). Patients in the exposed population were propensity matched 1:1 with patients in the control group. The primary outcome measure was morphine milligram equivalents (MME) per day within 30 days after ORIF. Welch two-sample T-test was used to determine a significant difference in opioid consumption for post-op pain management.
Results: 478 patients with a reported history of cannabis use underwent ORIF of a distal radius fracture in the study period. These patients were matched with 478 in the control group based on age, gender, and region. Patients with a history of cannabis use disorder on average consumed 42.41 MME/day (SD = 20.53) compared to 58.09 MME/day (SD = 34.20) in patients without history of cannabis use disorder (p < 0.0001). When breaking down MME/day in 10-day increments, significantly less opioids were consumed in each time period. 1-10 days post-surgery: 44.42 (SD = 21.56) vs 60.62 (SD = 21.56) MME/day (p < 0.0001); 11-20 days post-surgery: 37.72 (SD = 22.42) vs 54.69 (SD = 39.03) MME/day (p < 0.0005); 21-30 days post-surgery: 38.35 (SD = 25.20) vs 53.6 (SD = 40.69) MME/day (p <0.008).
Conclusion: Cannabis use is associated with a significant reduction in opioid consumption for pain management following distal radius fracture repair. In comparison to non-cannabis users, opioid consumption differences were maintained throughout the entire 30-day post-operative period. Further research is required to augment the potential opioid-sparing effects of cannabis use.
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